


AN ESSAY 



ON 



^ AND THE 

Umu anir ^mutu of Mtvtnvs 

IN THEIR TREATMENT. 

'illustrated by drawings 

OF THE 
DIFFERENT FORMS OF VENEREAL ERUPTIONS. 



BIT RICHARD C ABMICHAZIZ., M.a.IJ9L. 

nCE-PRESIDEKT OF THE HOTAL COLLEGE OF SURGEONS Ilf inELAND, AKD OJfE 

or THE SUKGEOXS OF THE RICHMOND SURGICAL HOSPITAL, 

DUBLIN, Sec. &C. &C. 



WITH PRACTICAL NQiTES, &c. 

BY G. EMERSON, M. D. 



> 



PHILADELPHIA :tj 

PUBLISHED BY JUDAH DOBSON, (AGENT,) AND A. SHERMAN. 
J. HARDING, PRINTER. 

1825 



TO 

SIR JAMES M^GRIGOR, M.D. F.R.S. 

PHYSICIAN EXTRAORDINARY TO THE KING, AND DIRECTOR 

GENERAL OF THE ARMY MEDICAL 

DEPARTMENT, 

Whose elevated office is a source of pride or gratifica- 
tion to him, only because of the ample opportunities 
which it affords him of advancing the cause of medical 
science — whose right to this appropriate tribute of 
respect is indisputable and exclusive ; as^ without his 
powerful influence in promoting this most important 
investigation in every corner of the globe occupied by 
Bintish soldiery, no efforts of mine, in this disregarded 
province of the empire, even though assisted by the 
warmest adherents of my vieivs in the ordinary walks 
of the profession^ could have established, at so early a 
period after their first promulgation, those truths, 
IV hie h have created so remarkable a revolution in the 
treatment of a class of diseases, the most perplexing, 
difficult, and unmanageable in the catalogue of human 
afflictions. The value of those truths he 7'ecognised 
as soon as they came within his knowledge ; and he 
encouraged^ their dissemination with, perhaps, still 
greater zeal, than if the author had been personally 
known to him, or had obtruded those opinions on his 
notice, which he has spontaneously honoured with so 
extensive and efficient a share of his attention. 

To him, therefore, to whose sagacity, intelligence, 
and candour, I owe so much ; and to whose liberality, 
vigilance, and indefatigable energy society is, in such 
a variety of ways, so deeply indebted, this treatise is 
gratefully and affectionctiely inscribed by 

His faithful and devoted fine nd, 

RICHARD CARMICHAEL, 



ADVERTISEiMENT. 



It is now ten years since the first edition of this work was 
submitted to the public. The novelty of the views, as well 
as the numerous host of facts adduced, perplexed the profes- 
sion at that time not a little ; and were it not for the authen- 
ticity of the latter, the former, by their boldness and opposi- 
tion to long established opinions, would hav^e been totally 
disregarded. The opinion of the profession, and of the pub- 
lic, has been since that period materially altered, and in place 
of the belief that no venereal complaint can be cured with- 
out mercury, it is now very generally acknowledged that 
every form of venereal disease may be successfully treated 
without that remedy. 

This fact, which no individual^ however extensive his 
practice, could satisfactorily establish, has been domonstrat- 
ed chiefly by the testimony of those enlightened surgeons of 
the army who, adopting my practice, prosecuted with great 
effect an enquiry for which their situation peculiarly adapted 
them. And it is now so firmly established, that I no longer 
think it necessary to burthen my work with an accumulation 
of cases, with a view of proving that mercury is not necessary 
for the cure of the greater proportion of venereal complaints. 
The reader, therefore, will find, that in this edition no new 
cases are adduced, except for the purpose of illustrating the 
treatment of some particular symptoms, chiefly those apper- 
taining to that congeries of symptoms which I have named the 
Phagedenic Disease. 

A vast deal of new matter, of the importance of which I 
leave others to judge, has been added, and the general arrange- 
ment of the work has been so materially altered, that were 
it not that I made use of some of the old materials of the first 
edition, and of those of my " Observations on the Uses and 
Abuses of Mercury," the present edition might be esteemed 
altogether a new work. 

It must be acknowledged that the profession are at present 
quite unsettled with respect to the treatment of venereal com- 
plaints ; so much so, that probably no two practitioners think 
alike on the subject, or pursue precisely the same mode of 



VI ADVERTISEMENT. 

treatment for their cure: This is exactly what might have 
been expected. The public mind, when thrown into doubt 
with respect to any long established usage, must take time to 
reflect and examine facts before it can settle upon the pro- 
priety of any new system. He must be Quixotic, indeed, in 
his expectations, who at so early a period, could look for more 
than this. But even in the present state of uncertainty, much 
good has arisen; for we seldom now witness a constitution 
run down by the excessive use of mercury ; or find that that 
medicine is now ever exhibited, when it is obvious that a con- 
sumptive tendency, or other causes, might render it hazar- 
dous to the patient's constitution : and I assert, that even if 
nothing more than this advantage were achieved by the in- 
vestigation, it has already conferred important benefits upon 
society. 

It is a fact, that the consumption of mercury has been ma- 
terially lessened within the last ten years. Many eminent 
apothecaries in this city have informed me, that there is not a 
sixth of the quantity consumed which was formerly used in 
the metropolis ; and 1 have not a doubt that even this pro- 
portion will continue to meet with a still farther reduction. 

Mankind are, however, at all times too apt to run into ex- 
tremes. Many think that because the use of this medicine 
has been carried to a needless and pernicious excess, that we 
can dispense with it altogether. From this opinion I most 
decidedly dissent. Mercury, I believe, when duly, considerate- 
ly, and appropriately applied, will be found a most useful aux- 
iliary ; but it is merely as an auxiliary, and not as an indis- 
pensable specific that I would wish to have it considered ; and 
it is one of the chief objects of this work to point out where 
it may be advantageously employed ; and where it ought to 
be avoided, as a far greater evil, than the poison against which 
it was intended to act as an antidote. 



ADVERTISEMENT TO THE FIRST EDITION, 

PUBLISHED IN 1814. 



The object of the following treatise is chiefly to elucidate 
an important class of diseases hitherto confounded with syphi- 
lis, but to which the attention of the profession has of late 
been attracted by Mr. Abernethy; and it will be satisfactory 
to state, in the first instance, the opportunities w^hich conduced 
to enable the author to investigate a subject requiring a very 
ample field of observation ; and, in the second place, to make 
the reader acquainted with the manner in which that investi- 
gation was prosecuted. 

The Lock Hospital of Dublin is probably the most exten- 
sive institution in Europe, for the exclusive reception of pa- 
tients affected with venereal diseases. It is supported by 
government, and, in general, contains from two hundred and 
eighty to three hundred patients. The hospital is visited 
daily by five surgeons,* each of whom attends his allotted 
wards; but the entire institution is, of course, open to the ob- 
servation of all ; so that each has the advantage of witnessing 
any peculiar or interesting case which may occur in this ex- 
tensive institution. 

The manner in which the investigation was prosecuted 
was on the most simple plan. Whenever a primary ulcer 
on the genitals occurred, which was destitute of the cha- 
racteristics of chancre, the hardened edge and base, it was treat- 
ed without the exhibition of mercury ; and the same system 
was pursued in those cases of constitutional symptoms which 
had a doubtful appearance. The scaly syphilitic blotch, as de- 
scribed in page 129 of Willan on Cutaneous Diseases, and 
the excavated ulcer of the tonsil, as described in page 482 of 
Hunter, t were alone esteemed to be syphilitic, and treated 
with mercury. 

* The constitution of the Lock Hospital of Dublin has since been ma- 
terially changed ; it now only contains beds for the admission of females ; 
and there are but two surgeons, one an attendant, the other a resident sur- 
geon. 

f The edition edited by Dr. Adams is referred to in this Work. 



Vill ADVERTISEMENT TO THE FIRST EDITION. 

As to the aflcction of the bones: "Whenever a patient com- 
plained of nocturnal pa'ms in the shafts of the long boneSyOrhad 
a decided node or enlargement of the bone, his disease was es- 
teemed syphilitic and the use of mercury adopted ;* but if the 
patient merely complained of pains in his joints, or if there 
was an indication, that the coverings of the bone only were 
affected by an inflammatory swelling, of a doubtful charac- 
ter, an occurrence which was not unfrequent, the employment 
of mercury was postponed, until the nature of the disease ma- 
nifested itself by indubitable syphilitic appearances. 

All the cases which did not coincide with these appear- 
ances, were carefully noted in the following manner: — 

1st. — The appearances of the patient at his admission were 
marked down ; his statement of his complaints, as far as could 
be collected from him, previous to his admission, was added ; 
and, lastly, the progress and treatment of his disease were 
noted, in general, but once in a week, but oftener, if the 
symptoms required any change of treatment. 

The cases were noted before an intelligent class of pupils; 
and the information contained in the following work, was de- 
tailed in general and clinical lectures during the two last win- 
ters, in which the nature of the diseases that have been con- 
founded with syphilis, were elucidated by a frequent refer- 
ence to the noted cases, and the pupils had opportunities of 
observing every variety of the symptoms of these diseases on 
the patients themselves in the hospital, and of contrasting them 
with those of true syphilis. 

Asa number of isolated facts can only acquire importance 
by leading to general conclusions, so it will be necessary in 
this work, in order to render it useful, to take a short view 
of circumstances already known. In the first instance, there- . 
fore, a brief view is taken of some morbid poisons, which 
stand in nearest relation to venereal diseases; under which 
denomination are included all complaints propagated by sex- 
ual intercourse: and the term syphilis is restricted to that dis- 
ease supposed to be brought to Europe by the followers of 
Columbus, about the conclusion of the fifteenth century. The 
symptoms of syphilis are next adverted to;t and afterwards, 

♦ It will be found in the sequel, that nodes occurred in other forms of 
venereal disease, besides that esteemed truly syphilitic, and were treated 
successfully without mercury. 

-j- In the present edition this order has been reversed ; syphilis, under 
the term of scaly venereal disease, from the character of its eruption, is the 
last considered. 



AI>VERTISEMENT TO THE FIRST EDITION. IS. 

the more immediate object of the work is entered on at large. 
By which prehminary matter, the nature of the pseudo-sy- 
philitic diseases, as they are termed by Mr. Abernethy, and 
the relation in which they stand to syphilis, and other conta- 
gious disorders, will be more clearly understood. 

Some novel, and probably important matter, will be found 
in the chapter which treats of syphilis; and those chapters 
that relate to the diseases which have hitherto been confound- 
ed with syphilis, are altogether the fruits of the author's ob- 
servation under the plan already explained. 



PREFACE 

TO THE 

SECOND AMERICAN EDITION. 

Investigations relative to the nature and treatment of vene- 
real diseases, commencing with the present century and carried 
on by some of the most able men of the age, have led to results 
subversive of the doctrines and practice hitherto inculcated 
by all the standard authors who have treated of this impor- 
tant subject. But it so often happens that innovations in medi- 
cine, though announced and received with all the eagerness 
and confidence of enthusiasm, are observed to sink when 
stripped of their novelty and specious gloss, that we are called 
upon to cherish suspicion as a professional virtue. It is only 
when this distrust becomes so great as to obscure reason and 
hinder inquiry, that it is to be considered as reprehensible ; 
for it certainly behooves us, in the present imperfect state of 
our science, to embrace with pleasure all such desirable im- 
provements as have withstood the test of time, and been con- 
firmed by the experience of the intelligent and dispassionate. 
Such, we think, should be the reception of the jiew principles 
and practice presented in this work by Mr. Carmichael, 
who has not only shown himself entitled to the credit due to 
Mr. Abernethy and other skilful pioneers, but to the still 
higher merit of having reduced his acquirements to systema- 
tic order. 

Perhaps there may be some who will think that the editor 
of the present American Edition has undertaken a useless 
task in superadding any thing to the work of the author. Al- 
though he could, if necessary, adduce many good arguments 
in favour of his undertaking, he will trust his justification to 
a very few. 

Plants of one soil usually undergo some variation when 
removed to another. This order of nature applies with great 
force to diseases, so that modes of treatment however well 
adapted to the climate and other circumstances of one country 
are not often perfectly applicable to those of another.* Some 

* Differre quoque pro natura locorum, genera medicinx; et aliud opus 
esse Romse, aliud ip ^g^^pto, aliud in Gallia.— Ce/s. Lib. 1. 



X 1 1 PREFACE. 

inoJifications will, therefore, oficn be found ^equi^ite to accom- 
mocJate the details of foreign works to new localities. For 
want of such adaptation, principles and discoveries have been 
often abandoned which otherwise might have augmented our 
stock of useful resources. Hence the utility of such comments 
as serve to point out variations, and to correct or confirm 
opinions and practice of foreign origin. To this task the 
editor felt himself strongly inclined, from having for many 
years followed in the same track with the author. Such in 
fact has been the success of his practice founded upon similar 
principles, that, independently of the testimony of other phy- 
sicians of this country, whose more ample opportunities have 
added the strongest confirmation, he ventures to recommend 
their general adoption v»-ith unhesitating confidence. Early 
led to commiserate the sufferings of those unfortunate fellow 
beings whom he beheld in hospitals and private practice a 
prey to inveterate disease, and almost sinking under the remedy, 
plans for amelioration were naturally suggested to his mind. 
He had been taught to believe that the slightest ulceration or 
abrasion upon the genitals called for the routine of salivation, 
which was seldom less than two or three months, and so violent 
as rarely to admit of recovery without some serious local or 
constitutional injury, and therefore felt no reluctance in aban- 
doning a miserable alternative when he discovered a course 
far more humane and efficacious. The established practice 
seems indeed to have fully verified the old opinion that the 
cure of the venereal disease, often entrusted to empirics and 
unskilful persons, is attended with the greater difficulty, that 
the repentance may be proportioned to the crime of unbridled 
lust and lasciviousness. That such ideas were formerly held 
by enlightened persons, may be inferred from the language of 
Dr. Paman, who, in a letter upon the subject written to Syden- 
ham, observes that — " he seems to have been touched with a 
sense of humanity and sin at the same time, who openly wished 
that (his foul distemper might be but once cured." Although 
the wise and good Sydenham showed the most sincere incli- 
nation to alleviate with becoming humanity the condition of 
those whom thoughtlessness and greater faults had subjected 
to misfortune, it may well be doubted whether his meritorious 
intention was achieved by his scruple doses of calomel and 
moderate salivations of two quarts a day. 

It may not be amiss for the editor to state, that so far from 
being inimical to mercury, he ranks himself among the truest 
friends to the cause of that invaluable medicine, regarding 



PREFACE. Xni 

those as its greatest enemies by whom it is indiscriminately 
and injudiciously employed. Those surely have reason to 
estimate its value most highly who find it can be employed 
with little or no inconvenience or injury to the patient, and 
with a certainty of its performing a cure. The popular no- 
tion of a mercurial disease superseding the venereal, he has 
always considered as founded in error, the specific title being 
generally misapplied to an aggravated train of syphilitic 
symptoms occasioned by the injudicious or immoderate use 
of mercury. As well might we call the injurious effects ari- 
sing from the improper administration of Peruvian Bark, for 
the cure of an autumnal fever, the Bark disease. The misno- 
mer in the one instance would not be exceeded by the other* 

Among those whose authority has greatly contributed ta 
sanction and favour the doctrines of Mr. Carmichael on this 
side of the Atlantic, the name of Professor Chapman stands 
deservedly conspicuous. From one of those coincidences 
which are by no means unfrequent in the relations of this 
and the mother country, he was early induced by the course 
of his inquiries to adopt and publicly inculcate in this city, 
views relative to venereal diseases very similar to those sub- 
sequently promulgated by Mr. Carmichael. The first edition 
of this work was gladly received, and promptly ushered be- 
fore the public by him. In his preface, he expresses his 
gratification at the support it afforded to his sentiments, hi- 
therto regarded as abominable heresies, and recommends it 
in strong terms to the students of the University of Pennsyl- 
vania. The value of the present work is greatly enhanced by 
a very considerable accession of original matter, the new and 
improved arrangement of the materials, a useful synopsis, ad- 
ditional plates, and what is of no less consequence, the in- 
creased weight to which the doctrines are entitled, from the 
ten years experience which they have since received. The 
editor has endeavoured to make the American copy more 
convenient as a book of reference for the practitioner and 
student, by the addition of a copious index, and the introduc- 
tion of practical notes wherever the text appeared to be defi- 
cient in detail. 

G, EMERSON. 

Philadelphia, November, 1825. 



CONTENTS. 



CHAPTER 1. 

PAGE 

Observations on those Morbid Poisons which stand in 
nearest relation to the Syphilitic, and evidence of the 
existence of Venereal Diseases which do not arise 
from that poison - 1 

CHAP. II. 

General observations on Venereal Diseases — their speci- 
fic distinctions, and appropriate mode of treatment - 38 

CHAP. IIL 
Papular Vftiereal Disease 67 

CHAP. IV. 

Pustular Venereal Disease - - - - 147 

CHAP. V. 

Phagedenic Venereal Disease - - - 162 

CHAP. VI. 

Scaly Venereal Disease 286 

CHAP. VII. 

Diseases most likely to be confounded whh those of Ve- 
nereal origin. — Synopsis of the Work * 341 



AN ESSAY 

ON 

VENEREAL DISEASES, 

AXD 

THE USES AND ABUSES OF MERCURY 

IN THEIR TREATMENT, &c. 



CHAPTER I. 

OBSERVATIONS ON THOSE MORBID POISONS WHICH STAND 
IN NEAREST RELATION TO THE SYPHILITIC, AND EVI- 
DENCE OF THE EXISTENCE OF VENEREAL DISEASES 
WHICH DO NOTARISE FROM THAT POISON 

It is a curious fact, that morbid poisons, which 
excite considerable fever, such as the small pox 
and measles, yield to the powers of the constitution, 
and are capable of a spontaneous cure, while, on 
the contrary, the poison of syphihs, which produces 
scarcely any fever, or one so low as in general to 
escape observation, yields so slowly and imper- 
fectly to those powers as commonly to require, for 
its extinction, the intervention of art. In the former 
instance, the increased action of the system is suffi- 



MORBID POISONS. 



cient to overcome the poison ; but, in syphilis, it 
seems to be nearly, if not altogether, insufficient. 
Thence, it would appear, arises the necessity, in 
this disorder, of artificially raising an action by 
means of mercur}?^ ; which, though capable of su- 
perseding the influence of the poison, does not, 
however, extinguish, like the natural fever in small- 
pox, the susceptibility of receiving the disorder 
again. 

From the accounts we have had of the yaws, a 
disease common among the African slaves in the 
West Indies, it seems to arise from a poison which 
holds a middle station between those of small-pox 
and syphilis, and has many symptoms which resem- 
ble those of both disorders. It may be suspended, 
but cannot be cured by mercury, or any other re- 
medy as yet discovered ; and the unassisted powers 
of the constitution, after a struggle of many months, 
at length subdues the poison, and the patient loses 
afterwards all susceptibility of the disease. The 
pustules in small-pox and yaws, we are told by 
Doctor Adams, in his observations on a case of the 
latter disease, are much alike;* each begins with a 
pimple, the law of each is to induce a slough, and 
each has its period and decline ; the powers of the 
constitution being in both equal to the cure. The 
constitution is susceptible of either but once during 
life ; but the chief difference between them is in 
the slower progress of the yaws, which commonly 
continues for many months before it is exhausted. 

*See Adams on Morbid Poisons, 2d ed. p. 196. 



THE YAWS. 



The ulcers of the throat which attend this disease, 
resemble those of syphilis so nearly, that, according 
to the same practitioner, it is impossible to distin- 
guish the one from the other; and this circumstance 
and the pustular eruption of the skin, which resem- 
bles that of small-pox, would lead us to class it as 
the connecting link between syphilis and small-pox, 
in the chain of contagious diseases. 

Dr. Bateman observes, in his Synopsis of Cuta- 
neous Diseases, " that the practitioners in the West 
Indies soon learned by experience, that active pre- 
parations retard the natural progress of the yaws, 
and that mercurials, although they suspended it, 
and cleared the skin of the eruption, yet left the 
patient still susceptible of, or rather, still impreg- 
nated with the virus ; which speedily evinced its 
presence by a re-appearance of the symptoms more 
severe and tedious than before. In truth, the dis- 
ease, it would seem, like the pustular and exan- 
thematous fevers of our own climate, will only 
leave the constitution after it has completed the 
various stages of its course, and removed the sus- 
ceptibility of the individual to future infection ; 
and no medicine, yet discovered, has had any influ- 
ence in superseding this action, or in accelerating 
its progress. Unless, therefore, any urgent symp- 
toms should require alleviation, (which seldom or 
never happens,) it is adviseable to dispense with the 
administration of medicine, and to be content with 
restricting the patient to a moderate and tempe- 
rate regimen, during the first stage of the malady. 
When the eruptions begin to dry, or as soon as they 



4 THE YAWS. 

cease to multiply and enlarge, the disease seems to 
require the same management as other slow and 
superficial ulcerations, accompanied with a cachectic 
state of the system ; viz. a light but nutritious diet, 
a dry and wholesome air, warm clothing, moderate 
exercise, and a course of tonic medicine, especially 
of sarsaparilla and cinchona, with the mineral acids, 
or with antimonials, and small doses of mercury, 
according to the circumstances of the individual 
habit. The effects of mercury, however, exhibited 
so as to excite salivation, as the early West India 
practitioners recommend, seem to be of a very 
questionable nature, especially when it is unaccom- 
panied by the vegetable decoctions ; and, it is cer- 
tain, that patients have, in some cases, soon recov- 
ered under the use of the latter, when the mercu- 
rials w^ere omitted. The native Africans employ 
decoctions of the bark of two or three trees, which 
are gently purgative as well as tonic; and likewise 
wash the sores with them, after carefully removing 
the crusts."^ 

Such are the observations on the yaws, which 
Doctor Bateman has collected from the writings of 
Doctor Winterbottom, and other medical men, w^ell 
acquainted with the disease in the West Indies. 
Upon reading them, I was forcibly struck with the 
strong coincidence which exists betw^een that di sease, 
and the constitutional form of some of those com- 
plaints which have been hitherto confounded with sy- 
philis. This coincidence is not only striking, with re- 

* Dr. Batemaa's Synopsis of Cutaneous Diseases, p. 313. 



SIVVENS. 



gard to their form, the eruptions being alike compos- 
ed of papulae and pustules, and attended with pains in 
the joints ; but also, in the circumstance, that, like 
the exanthemata, they will run their course, and not 
relinquish the constitution till they have completed 
their various stages. This is a remarkable fact, and 
will be elucidated in the course of this work, by 
the statement of a great variety of cases. We shall 
find that the exhibition of mercury, in those resem- 
bling diseases, produces the same effects as when 
prescribed for the yaws, viz. it may suspend the 
disease and clear the skin of the eruption, but will 
leave the patient still impregnated with, the virus, 
which evinces its presence as soon as the mercurial 
irritation has subsided, by a re-appearance of the 
eruption, or affections of the periosteum bones, and 
other deep-seated parts. 

It is supposed by many that sivvens, a disease 
endemic in Scotland, is a peculiar modification of sy- 
philis; but Doctor Adams who took particular pains 
to investigate the nature of this disease, and visited 
Scotland for the purpose, is of opinion that it is 
different, although approaching nearer to it than 
any other morbid poison with which we are ac- 
quainted. The primary ulcers of the two diseases 
have this difference, that the syphilitic are attended 
with a callous edge and base, and sivvens consists 
only in the clean phagedenic ulcer. In this parti- 
cular, as well as in several others, it appears to bear 
a very close resemblance to that form of venereal 
disease which I have termed phagedenic. 

The eruption is pustular, and hardens into a dark 



SIVVENS. 



brown crust. In syphilis we shall find that the 
eruption is scaly. Another circumstance universal- 
ly admitted, with respect to sivvens, in which it 
differs from syphilis, is, that it never attacks the 
bones but by the extension of an ulcer of the soft 
parts in their vicinity.* 

The primary symptoms of sivvens, we are inform- 
ed, usually take place on the lips and mouth, the 
disease being commonly communicated by drinking 
out of a vessel, or smoking with a pipe which had 
been previously used by a person infected ; and 
Doctor Adams remarks, that the ulceration can 
hardly be propagated, like syphilis, by the genitals, 
on account of the rapidity of the primary ulcers, 
which are attended with high inflammation. But, 
before we discard the supposition of its being dis- 
seminated by sexual intercourse, we should recol- 
lect, that phagedenic ulcers, attended with high in- 
flammation, are every day to be met with on the 
parts of generation. 

When we consider the constant communication 
that exists between the people of that part of Scot- 
land where the disease is most prevalent, and the 
inhabitants of the north of Ireland, it would be ex- 
traordinary to believe that the disease has not been 
communicated to this country : and, in fact, I am 
informed, by a medical friend, well acquainted with 
sivvens, that he met with many instances of it in 
the county of Antrim, but particularly in Belfast. 
It cannot be supposed, that the disease would re- 

* Adams on Morbid Poisons, p. 187. 



CANADIAN DISEASE. 7 

main confined to the north of Ireland, if once admit- 
ted into it; and I long suspected, that cases of siv- 
vens were to be met with every day in the Lock 
Hospital of Dublin, as I had observed many patients 
whose symptoms strongly resembled those which 
were pointed out to me in the hospitals of Edin- 
burgh and Glasgow, as constituting that disease. 
These conjectures were afterwards verified ; for in 
the summer of 1812, Doctors Hamilton and Heenan, 
of Glasgow, visited the Lock Hospital with me, 
and recognised the disease as that with which they 
were well acquainted in Scotland. The disease 
w^as in its constitutional form, and exhibited a good 
number of ulcers about the size of a shilling, cover- 
ed by large brown irregular crusts, and accompanied 
by a few pimples and pustules. 

This eruption disappeared under the use of so- 
lution of corrosive sublimate, and decoction of sar- 
saparilla; but, the above-mentioned practitioners 
informed me, that though the disease may be sus- 
pended by mercury, it will return after the most pro- 
tracted courses of that medicine ; an event which I 
have myself witnessed in more cases than one in 
the disease, which these gentlemen recognised as 
sivvens. 

There is a very imperfect account of a disease 
nearly resembling sivvens, by Doctor Swediaur, 
which made its appearance in Canada, shortly be- 
fore 1785, and became so general in that year, that 
five thousand eight hundred persons were discover- 
ed to be infected with it, besides many who con- 
cealed the disorder. The disease, we are informed, 



8 CAx\ADIAN DISEASE. 

from the statement of a Mr. Bowman, " first mani- 
fests itself by little ulcers on the lip, tongue, and 
inside of the mouth. These ulcers are of a very 
corrosive nature, and were observed in many chil- 
dren to have nearly destroyed the tongue. They 
first appeared in the form of little pustules, filled 
with a whitish purulent matter; the poison of which 
is so infective, that it communicates by eating with 
the same spoon, by drinking out of the same vessel, 
by smoking with the same pipe, na}^, it is even ob- 
served that it is communicated by linen, clothes, 
&c." We are also told that it seldom affects the 
genitals, and that, like the small-pox, " it is capable 
of being: communicated without immediate contact 
or coition." — " Children form a large proportion of 
the infected." 

The constitutional symptoms of this disease have 
a near resemblance to those of syphilis, sivvens, and 
the yaws, and chiefly consist of "buboes in the ax- 
illae, groin, or throat, which sometimes inflame and 
suppurate, and at others, remain hard and indolent." 
Also "tetters, itching crusts, and ulcers, which appear 
coming and going in different parts of the body." 
" Pains in different parts, which increase during the 
night time, or when the patient takes some violent 
exercise." — " The bones of the nose, palatum, cra- 
nium, clavicula, tibia, arm and hand, grow carious, 
or tophi appear in several parts of the bones ; at last, 
pains of the breast, cough, loss of appetite, sight, 
hearing, smell, and falling off of the hair, close the 
scene before death." The disease we are told is 
contagious in all its stages, and may continue to 



CANADIAN DISEASE. 9 

harass the patient for many years ; but it is worthy 
of observation, that Mr. Bowman saw some children 
who recovered without the aid of medicine. 

The mode of treatment is very imperfectly de- 
tailed. We learn " that dock and burdock roots, 
sarsaparilla and spruce have been generally made 
use of, and with some appearance of success : most 
success, however, has been observed from a decoc- 
tion of the branches of hemlock spruce, (a tree so 
called on account of the resemblance of its smell to 
hemlock;) but we are afterwards informed, that 
none were cured radically without mercury, and 
that it is necessary to continue that medicine three 
weeks after all symptoms have disappeared."* 

From the whole of the information to be derived 
from the imperfect account of this disease in Doc- 
tor Swediaur's work, I should be inclined to infer, 
that, like the yaws and sivvens, it is capable of 
yielding to the powers of the constitution, and that 
mercury is only of service, when the disease is on 
the decline, and has begun to yield to those powers. 
For if that medicine was capable of curing the dis- 
ease, with the same certainty as attends its employ- 
ment in syphilis, we should not find those vegetable 
remedies resorted to in the first instance, which, ac- 
cording to Mr. Bowman's account, greatly forward- 
ed the recovery of the patients; yet it seems they 
were not radically cured without the assistance of 
mercury, although in another place, we are inform- 

* Practical Observations on Venereal Complaints,, p. 169, 

B 






10 LEPRA SEPTENTRIONALIS. 

ed, that some affected with the disease, recovered 
without the aid of that medicine. 

However, the circumstances detailed, I conceive, 
afford sufficient grounds to conclude, that the Cana- 
dian disease is not syphilitic, but that it is another 
instance of a contagious malady which commences 
with ulceration, and is followed by bubo, eruptions, 
and ulcers of the skin, pains, nodes, and caries of 
the bones. A train of symptoms very generally 
supposed to appertain exclusively to the syphilitic 
poison, but which, as I hope to convince my reader,^ 
may derive their origin from primary ulcers which 
are not syphilitic, and are still more common in this 
country than syphilis itself. 

There is another disease similar, if not identical 
with sivvens and the Canadian distemper, which in- 
fests the maritime parts of Norway, some provinces 
of Sweden, and the northern parts of Russia. It is 
also found, as we learn from Callisen, on the shores 
of Iceland, in all the Feroe Islands and in some pro- 
vinces of Scotland. This disease, which is called 
radesyge by the Norwegians, and is denominated 
lepra septentrionalis by Callisen,* commences with 
the premonitory symptoms of lassitude, want of ap- 
petite, severe pains resembling those of rheuma- 
tism, rigidity of the limbs, dyspnoea, and violent 
headach; the face either assumes a singular shin- 
ing silvery appearance, or a deep red or livid colour. 
These feverish symptoms may continue for many 

* Systema Chirurgiae, torn. i. p. 490. 



LEPRA SEPTENTRIONALIS. 1 1 

maiiths, before the formidable train of maladies to 
which they are the prelude, ensues. A dry branny 
efflorescence of the skin first takes place; the rege- 
nerated cuticle gradually becomes more rough and 
thickened. In many patients there occurs an erup- 
tion of small spots of various colours not larger 
than flea bites. These appearances are, however, 
but the precursors of copper-coloured tubercles or 
knots on the skin, and herpetic spots on the fore- 
head, nose, chin, lips, and eyebrows; afterwards 
they become scattered over every part of the body. 

The integuments of the forehead become thick- 
ened and corrugated, the eyelids swell and are 
everted, the bloated cheeks assume a livid colour, 
in fact the entire countenance becomes frightfully 
distorted. The spots afterwards degenerate into 
malignant ulcers, which even extend to the bones 
underneath, and render them carious. Every part 
of the fauces is also liable to be affected with simi- 
lar tubercles and ulcers which extend to the nares. 
The bones of the palate and nose soon become ca- 
rious. Frightful deformity ensues; and the patient, 
exhausted by so great an extent of disease, dies of 
hectic fever. 

Such is the account of a malady which has long 
ravaged the coasts of the northern peninsula. It 
has of course attracted the particular attention of 
the medical men of Norway. I have had the ad- 
vantage of conversing with a respectable member 
of that body. Doctor Hoist of Christiana, when he 
visited this city a few years since, on the subject, 



12 LEPRA SEPTENTRIONALIS. 

and from whose accurate work* I have chiefly taken 
the above detail. 

It is not considered by him, or I believe by any 
of the numerous authors who have written on the 
subject, as arising from sexual intercourse, but is at- 
tributed to the mode of living followed by the north- 
ern Swedes and Norwegians, but more particularly 
by the fishermen inhabiting the coasts of these high 
latitudes. Indeed he draws a picture not very in- 
viting of rural life in this part of the world. Their 
houses or huts are low, damp, and rarely consist of 
more than one apartment, in which the entire fami- 
ly (with the smaller domestic animals of the esta- 
blishment) remain for many days and nights toge- 
ther, and in which they eat, drink, and cook their 
victuals. Into these wretched hovels the air is 
never intentionally admitted, the windows, which 
are scarcely pervious to the light of the sun, being 
always closely bolted down. The fishermen return- 
ing from their laborious occupations in these rainy 
and stormy regions hang their clothes soaked in 
wet, or embued with the filth of fishes, to dry in 
their smoky huts, which still adds to the impurity 
of the air. The food of the inhabitants is of the 
most rancid description, and consists chiefly of salt 
dried beef and pork, and too often semi-putrid fish. 
They have no esculent vegetables; and are fre- 
quently under the necessity of using in place of 
bread the pulverized bones of fishes, or the dried 

* Morbus quem radesyge vocant, kc. auctore Frederico Hoist, 
M. D. Christiana, 1817. 



LBPllA SEPTENTRIONALIS. 13 

fish itself, mixed with the bark of trees or with Ice- 
land moss. 

Is it then to be wondered at that people leading 
such a life, living on the most rancid, indigestible 
food, breathing a pestilential atmosphere, and filthy 
in their persons, should suffer the necessary conse- 
quence of such habits in the attacks of the dreadful 
disease in question ? 

The chief part of Dr. Hoist's work is occupied 
with a consideration of the best mode of averting 
this evil, and it consists of course in recommending 
ventilation, cleanliness, bathing, and the cultivation 
and use of esculent vegetables. 

We learn from Callisen, that the disease admits 
of cure during the first stage, before the eruption 
occurs, and even afterwards, under favourable cir- 
cumstances. The methodus medendi consists in re- 
moving all the causes of the disease enumerated; 
the use of baths, and a milk and vegetable diet, with 
fresh animal food. With respect to medicine " ci- 
cuta, trifolium fibrinum, cortex ulmi, rosmarinus 
sylvestris, evacuentia leniora, et antimonialia," are 
those he recommends. As to mercury, he observes, 
that carried to the extent of salivation, it always 
proves injurious; and that all external repellents 
are to be strictly avoided, as they drive the disease 
from the surface to the more important internal or- 
gans. 

Doctor Hoist, from the circumstance that this 
disease begins with fever, which ushers in an erup- 
tion, conceives that we would be right in classing 
it with the exanthemata, were it not for its tedious- 



J 4 BUTTON SCURVY. 

ness; and therefore places it between the exanthe- 
mata and cachexiae.* I leave this objection for 
others to consider ; for my own part, since it pos- 
sesses the true essentials which characterize the ex- 
anthemata, — fever followed by eruption, — I should 
feel no hesitation in placing it amongst them. 

It appears to me extremely probable that sivvens 
is the same disease, rendered milder by the im- 
proved habits of the peasantry of Scotland, and the 
use of vegetable aliment ; and that this is the dis- 
temper to which Callisen alludes, when he says 
that the lepra septentrionalis is found in Scotland. 

There is an eruption, peculiar, I understand, to 
this country (Ireland,) termed by the natives the 
Button Scurvy. It has not, I believe, been men- 
tioned by any medical writer, and certainly has not 
been noticed by either Wilian or Bateman. It is so 
general that I am seldom without a case or two of 
it in the hospital ; but never yet saw an instance of 
it in the better ranks of society; nor even among 
the manufacturers or artisans who live in the city. 
In the instances I have seen, as far as my recollec- 
tion extends, it was only found among the peasantry" 
engaged in agriculture. The spots of this eruption 
are convex iubercles, varying from the size of a split 
pea to that of a shilling, seldom so large as half-a- 
crown ; they exhibit an appearance somewhat like 
the surface of a raspberry, and discharge a white 
tenacious matter, which forms thin yellow crusts, 

* Hisce expeditis abstrusi mali naturam adeo tamen perspec- 

tam cognitamque habemus, ut inter exanthemata cachexiusque idem 
referre audeamus. Hoist, p. 37. 



ON DISEASES RESEMBLING SYPHILIS. 15 

that are in general rubbed ojff by tlie patient's 
clothes. The spots are seldom seen on the face, 
but are scattered over the trunk and extremities, 
and are almost always observable on the inside of 
the thighs, or close to the axillge. The general 
health does not appear disturbed ; but whether it 
is ushered in by pyrexia, I have not ascertained, 
not having witnessed any case at its commence- 
ment. This disease, which continues for months, 
nay, years, on the same individual, is generally 
cured by the use of the tepid bath, and the exhibi- 
tion of pitch pills, in as large doses as the stomach 
can bear, in the course of six or seven weeks. I 
notice the disease here, because the eruption might 
be readily mistaken by those unacquainted with it, 
for that which attends the phagedenic venereal dis- 
ease ; and because I believe that no account of it 
has as yet been published. As it is found only in 
one class of society, it is probably owing to the pe- 
culiar habits of that class ; and the smoky, unventi- 
lated, and filthy state of the habitations of the 
majority of the peasantry of this country, with inat- 
tention to personal cleanliness, may well account 
for the presence of any chronic cutaneous disease. 
Whether or not it is infectious I am ignorant ; but 
believe it is not, although it is generally thought to 
be so by the country people. 

The organs of generation are subject to a variety 
of ulcers, destitute of the characteristics of chancre — 
the hardened edge and base ; yet most practitioners 
look on them as chancres, and treat them as such, 
imagining that inflammation, peculiarity of consti- 



16 GENERAL OBSERVATIONS 

tution, or some accidental circumstance, has de- 
prived them of the usual character of the primary 
syphilitic ulcer. 

To discover whether chancres may be altered 
by peculiarity of constitution, or accidental causes, 
we should look to the analogous symptoms of other 
contagious diseases, and inquire, whether the pus- 
tule of small-pox, or the vesicle of cow-pock is^ 
ever so altered, as no longer to display the charac- 
teristic marks by which they are distinguished the 
one from the other, and from all diseases with which 
they might be confounded. 

It must be admitted that these diseases are obe- 
dient to certain laws, from which there is seldom or 
ever any departure ; and if any deviation does oc- 
cur, it is not sufficient to deprive the disease of 
those characteristics by which it is distinguished 
from other disorders. Thus, small-pox is seldom 
so varied from its usual appearance, as to be mis- 
taken by any practitioner of experience for any 
other disease. It is the particular law and charac- 
ter of the small-pox poison, as Doctor Adams re- 
marks, to form a slough under every individual 
pustule, and this essential property of the disease 
is never wanting. We never find, says that accu- 
rate observer, the pustules running into phagedenic 
ulcers, or throwing up a callous edge and base like 
chancre. If the disease is in excess, as when the 
pock is confluent, the character of the poison is 
only more strongly heightened, and the sloughs be- 
come more extensive. 

Cow-pock is as strong an intanee of the same re- 



ON DISEASES RESEMBLING SYPHILIS. 17 

gularity. If the vesicle of the cow-pock is broken, 
we often find a troublesome ulcer succeed, yet the 
areola is never absent at the usual period, which is 
looked upon by many as the most marked charac- 
ter of that poison. The yaws, sivvens, and other 
poisons mentioned, seem to have their appropriate 
laws and stated appearances, from which there is 
no departure. Why, therefore, should we suppose 
that peculiarity of constitution, or any adventitious 
circumstance, should prevent the syphilitic poison 
from producing its accustomed and characteristic 
effects? It is rational to think, that its laws are as 
invariable as those of small-pox, cow-pock, or any 
other morbid poison with which we are acquainted. 
But, in those ulcers which have hitherto been con- 
sidered as syphilitic, we should expect the presence 
of the hardened edge and base, if they were caused 
by the poison of syphilis; and, in the phagedenic 
and sloughing ulcers, whose ravages seem to have 
arisen to the very acme of virulence, we should 
naturally expect to find the hardened edge and base 
marked with the greatest strength of character; yet, 
we find, on the contrary, these peculiarities are to- 
tally wanting, from the mildest to the most destruc- 
tive of those ulcers. 

In an inquiry like the present, it should not be 
forgotten, that the very organization, secretions, and 
functions, of the genitals, dispose them to ulcera- 
tion beyond all other parts of the body. 

They are organized in the highest degree ; their 
secretions are various, their functions complicated 
with those of the urinary organs, they are at one 



18 TESTIMONIES 0> THEIR EXISTENCE 

moment in a state of quiescence, and the next in a 
state of the highest excitement. 

Their secretions, particularly in the female sex, 
are liable to become vitiated, and consequently 
acrimonious and irritating, and the same effect may 
follow from inattention to cleanliness. The parts of 
generation must, therefore, be disposed more than 
others, to derangement in their functions, and, con- 
sequently, more subject to the ravages of ulceration. 

Since Mr. Hunter's work upon the Venereal 
Disease, it is very generally admitted, that not only 
certain modifications of animal matter, but the 
healthy secretions of one animal applied to a sus- 
ceptible or crude surface of another, is capable of 
exciting ulceration. It is unnecessary to add how 
frequently this occurrence must take place during 
sexual intercourse ; and, from the facts and obser- 
vations brought forward by Mr. Hunter, and Mr. 
Abernethy, it appears that this local ulceration may 
be followed by constitutional symptoms, resembling, 
in some degree, those of syphilis, viz. eruptions on 
the skin, ulceration of the throat, and affections of 
the bones. 

These facts are proved and elucidated by those 
diseases which are induced by the suckling of chil- 
dren, and the transplantation of teeth, as mentioned 
by Mr. Hunter, and which I shall consider more at 
large in its proper place. 

The frequency of ulcers on the genitals, not aris- 
ing from the poison of syphilis, is fully proved by 
the testimony of authors who wrote on the subject 
previous to the latter end of the fifteenth century, 



BEFORE THE INTRODUCTION OF SYPHILIS. 19 

when syphilis was first observed in Europe, and 
who could not fall into our error of imputing every 
ulcer on the genitals to that source. Celsus describes 
eight species of ulcers to which the organs of gene- 
ration are subject;* three of which are at present 
as common as the syphilitic ulcer, viz : an ulcer 
which causes phymosis, but is readily cured by de- 
tergent washes : and the phagedenic and sloughing 
ulcers ; for the former of which he recommends the 
actual cautery, a certain proof of its obstinacy ; and 
the other he describes as beginning with a slough, 
and which is prevented with difficulty from spread- 
ing to the bladder. 

Other ancient writers, Greek, Roman, and Ara- 
bian, as Hippocrates, Galen, Paulus ^gninetae, and 
Avicenna, describe ulcers of the genitals as common 
and frequent occurrences. 

The indefatigable Astruc, not contented by ad- 
ducing a sufficient body of evidence to remove 
doubts from the minds of the most sceptical, in or- 
der to prove that syphilis was not known in Europe 
before the year 1494, also examines the writings of 
a number of physicians and surgeons, who lived 
before that time, which seemed to contradict these 
testimonies. 

The following are a few of those passages, and 
are confined to authors who flourished between 
1270 and 1470 ; and by them Ave are distinctly in- 
formed of the infectious nature of some ulcers of 
the genitals ; — 

* Celsus, Edinburgh edition, 1809, p. 330 to 335, 



20 TE5TI5IONIES OF THEIR EXISTENCE 

" Gulielnius de Saliceto. a physician of Placenza, 
obsen'es, in his chapter De apostemate in Ingui- 
bus. that a bubo sometimes comes upon a foulness 
of the penis, contracted by lying with a slovenly 
woman.'' 

" Lanfranc of !Milan states, that ulcers proceed 
from hot pustules growing upon the penis, which 
afterwards burst, or from sharp humours ulcerat- 
ing the part, or from coition \^*ith a foul woman, 
who had lately had to do with a man whose penis 
was ulcered." 

Bernard Gordon. Professor of Physic in the Uni- 
versity of Montpelier, states that the diseases of the 
penis are numerous as impostumes, ulcerations, 
cancers, inflation, pain, and itch." 

"Guido de Cauliaco, in his Chirurgia Magna, also 
treats of heat and foulness of the penis from lying 
with a foul woman." 

" Velescus de Taranta, Professor of 3Iontpelier, 
in his Chapter de Uiceribus et Pastulis Virga?, 
states, that ulcers break out upon the penis from 
coition with a woman who has an ulcer in the 
matrix." 

'• And, lasth', Peter de Argeleta, of Bologna, 
Doctor of Arts and Physic, has a chapter, entitled 
De Pustulis quae adveniunt Virgae, propter Con- 
versationem cum fosda 3Iuliere, quae albce sunt vel 
rubrae."* 

Astruc contends, that the difierent ulcers and 
buboes, mentioned by these authors, could not have 

* See Astruc, Book L p. 41. 



BEFORE THE INTRODUCTION OF SYPHILIS. 21 

been syphilitic, because they were found to yield 
to external applications, and that internal medicines 
were not thought necessary. " Whence it is plain," 
he says, "they did not treat of venereal ulcers, 
w^hich are not so easily cured." 

He also adduces the testimony of John de Vigo, 
who wrote about the period in which syphilis first 
became known ; and who, as might be supposed, 
found it necessary to la}^ down diagnostics, by which 
the new disease, syphilis, might be distinguished 
from the ulcers to which the parts of generation 
were at all times subject. 

After describing the characters of those ulcers of 
the genitals, which were at all times known, John 
de Vigo proceeds (lib. v. cap. 1.) to detail the ap- 
pearances of the new disease, and states, " That ve- 
nereal pustules, from infectious coition, arise in the 
genitals : viz. in the vagina in women, and on the 
penis in men, and are sometimes of a livid colour, 
sometimes black, and sometimes whitish, with a cal- 
losity surrounding them^ 

It is satisfactory to remark how soon the sur- 
rounding callosity of chancre caught the observa- 
tion of practitioners, and how early it was esteemed 
the characteristic and distinguishing mark of the 
primary syphilitic ulcer; but the necessity of at- 
tending to this discrimination was soon forgotten, 
and has been, to this day, most strangely neglected 
by the great body of practitioners. 

Those other ulcers to which the parts of genera- 
tion were at all times liable, began soon to be con- 
founded with the new disease ; and we find authors 



22 TESTIMONIES OF THEIR EXISTENCE 

stating, that it was only occasionally that the callo- 
sity surrounded venereal ulcers. Nicholas Massa, 
for instance, in the year 1532, observes, "that fre- 
quently obstinate ulcers on the penis appear, at- 
tended with surrounding induration, which are cured 
with great difficulty." And Aloysius Lobera, phy- 
sician to Charles V. about the year 1540, says, " that 
sometimes the patient is affected with ulcers on the 
penis, which are hard and callous, and that this ap- 
pearance is a certain mark of the French disease."* 
But to return to our subject, we learn from the 
authorities collected by Astruc, the prevalence of 
infectious ulcers on the organs of generation, long 
previous to any knowledge of syphilis. But the 
most curious document he produces on the subject, 
is a transcript of the statutes made by Jane I. Queen 
of both the Sicilies, and Countess of Provence, for 
the regulation of the public stews established at 
Avignon in 1347. He takes no small pains to con- 
firm their authority, but whether their truth, or the 
decorum of the high personage to whom they are 
ascribed, stand in the most questionable predica- 
ment, I shall venture to quote the fourth of these 
very salutary enactments, w^hich is as follows: "The 
Queen commands, that on every Saturday, the wo- 
men in the house be singly examined by the abbess, 
and a surgeon appointed by the directors ; and if 
any of them has contracted any illness by their 
w^horing, that they be separated from the rest, and 
not suffered to prostitute themselves, for fear the 

* See Astruc, Book I. p. 97. 



BEFORE THE INTRODUCTION OF SYPHILIS. 23 

youth, who have to do with them, should catch their 
distempers.""^ In fine, there is scarce an authority 
collected by Astruc, which does not, directly or in- 
directly, point out the infectious nature of the ulcers 
in question, and inform us, that buboes were fre- 
quent attendants upon them : but, it must be acknow- 
ledged, that we do not find any intimation that con- 
stitutional symptoms were observed to follow the 
attack of the ulcers. With the view to ascertain 
this fact, I shall examine the writings of Mr. Wil- 
liam Becket. But even if we were without any tes- 
timony whatever, that constitutional symptoms were 
the consequence of these venereal complaints, 
which, as we have seen, infested Europe at all 
times before syphilis was known, it does not follow 
that such symptoms did not exist. For although 
the ancients may have had them before their eyes 
every day, yet they might not have had any suspi- 
cion of their origin, or a conception of the connex- 
ion that exists between the primary ulcer of a mor- 
bid poison, and the constitutional maladies which 
follow it. Even when syphilis first appeared, it was 
thought to be epidemical ; and, like other pestilen- 
tial distempers, to be owing either to " the malig- 
nant influence of the stars," — " an unwholesome dis- 
position in the air," — " a spontaneous corruption in 
the humours contracted by an error in diet, or the. 
abuse of the non-naturals." Of the latter opinion 
we find was Benedict Victorius ; who, in the third 
chapter of his book, De Morbo Gallico, published 

* Astruc, Book I. p. 61. 



24 TESTIMONIES OF THEIR EXISTENCE 

ill Florence in 1551, protests, " that he is firmly per- 
suaded, that the infection itself is not absolutely 
necessary for producing the venereal disease ; but 
that the state of the air, together with that of the 
putrid humours, are sufficient." But, to put the 
matter beyond all doubt, he testifies, " that he hap- 
pened once to know some honest and religious nuns, 
who were confined in the strictest manner, unfor- 
tunately contract the venereal disease from the pe- 
culiar state of the air, together with that of the pu- 
trid humours, and the iveakness of their habit of 
body."* 

It was supposed for several years, that the in- 
fection of syphilis was conveyed, like the plague, 
from one person to another ; hence, those who were 
infected, were driven from society into the very 
forests ; and, in large cities, it was conceived neces- 
sary to provide for the public safety, by the most 
severe laws against these unfortunates. Thus, there 
is extant a decree in the acts of the parliament of 
Paris, dated the 4th of March, 1496, by which such 
as were infected with the venereal disease were 
prohibited, under pain of death, from conversing 
with the rest of the world, and obliged i6 retire in- 
to the suburbs of St. Germain's, to places set apart 
for their reception."! 

In the year 1717, Mr. Becket, the writer I have 
alluded to, presented a paper to the Royal Society, 
in which he endeavours to prove the antiquity of 



* Astruc, Rook II. Chap. I. p. 118. 
tAstruc, Book I. p. 110. 



BEFORE THE INTRODUCTION OF SYPHILIS. 2^ 

the venereal disease, and that it was known long 
before the discovery of the West Indies. He un- 
doubtedly fails in his prime object, but he suffi- 
ciently demonstrates the frequent occurrence, at 
the period in question, of gonorrhoea, and ulcers of 
the genitals, as also constitutional affections, which 
were esteemed to be symptoms of leprosy. 

In this enquiry, he confines himself entirely to 
those diseases as they occurred in England. He 
contends, that the term brenning, or burning, for 
many hundred years was used to signify the same 
disease which we now call a gonorrhoea. This he 
endeavours to prove in many ways. 

1. There were licensed stews in those times, 
under certain rules. Among the regulations rela- 
ting to the lordship of Winchester in 1162, it is or- 
dained, that no stew-holder shall keep any woman 
who hath the perilous infirmity of burning, under 
the penalty of a hundred shillings; which was a 
very sufficient precautionary measure; for it has 
been ascertained that such a sum, in that day, was 
equivalent to seventy-five pounds of our money. 

2. He quotes a passage from the manuscript of 
John Arden, surgeon to Richard II. in 1380, in which 
the brenning is defined to be an inward heat and 
excoriation of the urethra, and capable of being 
cured by local means. Among several passages 
which he quotes from old English authors, the fol- 
lowing is most deserving of attention. It is from a 
work written by Andrew Boord, Doctor of Physic 
and Romish Priest, printed in the reign of Henry 
Vm. in the year 1546. " If a man," he say$ "be 



26 TESTIMONIES OF THEIR EXISTENCE 

burnt of with a harlot, and do meddle with another 
woman within a day, he shall burn the woman that 
he shall meddle withal;" and, as an immediate 
remedy against the burning, he recommends tbe 
" washing of the pudenda two or three times with 
white wine, or else with sack and water ; but if the 
matter have continued long, he prudently advises 
the patient to go to an expert surgeon, to have 
help." — " In another chapter, he gives advice what 
is to be done if the patient gets a dorser or two ; 
so called, from its protuberancy, or bunching out ; 
for, at that time, the word bubo was mostly made 
use of to signify that sort of swelling which usually 
happens in pestilential diseases." 

The subject is continued by Becket, in a second 
paper, inserted in the 31st vol. of the Philosophical 
Transactions, in which we find the following obser- 
vations. "John Arden, surgeon to Richard II., 
takes notice of those contumacious ulcers, which 
we now call chancres, and the great trouble our an- 
cient authors found in attempting their cure, suffi- 
ciently discover them to have had their original 
from a venereal infection." He afterwards pro- 
ceeds to give a quotation from a manuscript in 
Lincoln college, by Thomas Gascoigne, Chancellor 
of Oxford, dated 1430, who states, that he knew 
many men to die of a disease gotten by a connexion 
with women, which caused a putrefaction of the 
genital organs and of the entire body ; among whom 
was the celebrated John of Gaunt,* who, before his 

* Mortuus est ex tali putrefactione membrorum genitalium et 
Corporis sui causata per frequeDtationem mulierum. 



BEFORE THE INTRODUCTION OF SYPHILIS. 27 

death, sent for his nephew, Richard II., to witness 
the ravages of his distemper, and receive a salutary 
lesson from his misfortunes. 

The remainder of Becket's paper is an endeavour 
to prove, that the venereal disease was constantly 
confounded with leprosy; and, indeed, he brings 
forward sufficient facts to evince, that diseases ac- 
quired by sexual intercourse, which afterwards af- 
fected the skin and the bones, were esteemed to be 
symptoms of leprosy. 

With this view, he gives a quotation from John 
Gadissen, a very learned and famous Physician, 
that flourished about the year 1340. In a work he 
entitles Rosa Anglica, speaking of the mode of pre- 
venting infection from connexion loith a leprous 
person^ he says, " sed siquis vult membrum ab omni 
corruptione servare cum muliere recedit, quam forte 
habet suspectam de immunditie, lavet illud cum 
aqua frigida mixta cum aceto, vel urina propria in^ 
tra vel extra preputium." "From hence," says 
Becket, " some of their leprous women, (as they 
called them) were capable of communicating an in- 
fectious malady to those that had carnal connexion 
with them ; which proves, that the pudenda of wo- 
men must be diseased, inasmuch as we are abso- 
lutely assured, that infections of that nature only 
happen where a sound part comes into contact with 
a diseased one ; for the symptoms always first dis- 
play themselves in those parts through which the 
virulency is first conveyed. Now, in a leprosy, we 
never meet tvith the mention of any disorder in those 
parts; which, if there be not, must absolutely se- 



28 TESTIMONIES OF THEIR EXISTENCE 

cure the person from having that disease communi- 
cated to him, by coition with leprous women ; but, 
it proves, there was a disease among them, which 
was not the lepros}^, although it went by that name." 
These observations of Becket, I conceive, are un- 
answerable, if it is allowed that leprosy is a disease 
incapable of being communicated by coition. On 
this part of my subject the following passage, in 
Dr. Bateman's Synopsis of Cutaneous Diseases* is 
so apt, that I shall take the liberty of transcribing 
it. "Notwithstanding the care with which the se- 
paration and seclusion of lepers have been enforced, 
in compliance with the ancient opinion, there is 
great reason to believe, that elephantiasis is not 
contagions. M. Vidal long ago controverted that 
opinion, having never observed an instance of its 
communication from a leprous man to his wife, or 
vice versa^ although cohabiting for a long series of 
years. Dr. T. Heberden daily observed many ex- 
amples of the same fact, in Madeira ; and affirms, 
that he never heard of any one who contracted the 
distemper by contact with a leper. And Doctor 
Adams has more recently given his testimony to 
the same truth ; remarking, that none of the nurses 
in the Lazar House in Funchall, have shown any 
symptoms of the disease ; and that individual La- 
zars have remained for years at home, without in- 
fecting any part of their family." 

In those details we find strong reasons for be- 
lieving, with Becket, that disorders which com- 
menced on the organs of generation, and afterwards 

* Page 296. 



BEFORE THE INTRODUCTION OF SYPHILIS. 29 

affected the constitution, were very general ; and 
that they ivere confounded with, and mistaken for 
leprosy. Becket mentions, that it was very much 
the practice, among physicians in England, to smear 
the ulcers, which they conceived to be leprous, with 
mercurial ointment. This, on account of the great 
number of the ulcers, frequently brought on saliva- 
tion ; and the ulcers, to their astonishment, healed. 
But he argues, that as it is universally acknowledged 
that mercury does not cure a true leprosy, it follows, 
that those ulcers which became well under the use 
of that medicine, were not leprous, but belonged to 
another disease. 

Venereal nodes on the bones, the same writer 
contends, were common before the time assigned 
to the introduction of syphilis into Europe; and 
" that they were termed by the old English writers, 
the Boon, or Bone Hawe; a name which gives us 
a perfect idea, not only of the part affected, but af- 
ter what manner it was diseased ; for the old Eng- 
lish word hatve, signified a swelling of any part. 
Thus, for instance, a little swelling upon the cornea 
was anciently called hawe in the eye; and the 
swelling that frequently happens on the finger, on 
one side of the nail, was called the white hawe, 
and, afterwards, white-flaw." 

Such are the facts stated by Becket ; from which 
we learn, that a running from the urethra, and ul- 
cers on the genitals, followed by diseases of the 
skin and bones, which yielded to mercury, but 
which were generally looked upon as symptoms of 
leprosy, were common in England before the period 



30 TESTIMONIES OF THEIR EXISTENCE' 

when syphilis was first observed in Europe. We 
cannot conclude with him that these complaints 
were symptoms of a true syphilis, and that that dis- 
order was at all times prevalent in Europe; because 
there exists the strongest evidence, in the writings 
of all medical authors, about the year 1500, that 
syphilis was a new disorder, and baffled the skill of 
the most eminent physicians. On the whole, it 
will scarcely be disputed, that syphilis was first 
brought to Europe by the followers of Columbus ; 
and that, previous to that event, there existed, 
throughout the Old Continent, venereal disorders, 
both local and constitutional, which strongly resem- 
bled the new-imported disease, and, to the disgrace 
of our profession, (with two or three splendid ex- 
ceptions) have continued from that day to the pre- 
sent, more than three centuries, to be confounded 
with it by the general body of practitioners. 

It is to Mr. Hunter we are indebted for the first 
steps in an inquiry, which is of the greatest con- 
sequence to society, inasmuch as it is likely to pre- 
vent the indiscriminate and excessive employment 
of mercury, in diseases which do not require it, or 
are prejudiced, more or less, by its use. 3Ir. Hun- 
ter observes, "that diseases which resemble others, 
seldom do it in more than one or two of the symp- 
toms; therefore, whenever the nature of the disease 
is suspected, the whole of the symptoms should be 
well investigated, to see whether it agrees in all of 
them with the disease it is suspected to be, or only 
in part. This observation,*' he continues " seems 
to be more applicable to the venereal disease than 



INDEPENDENT OF SYPHILITIC INFECTION. 31 

any other; for there is hardly any disorder that has 
more diseases resembling it in all its different forms 
than the venereal disease ; and when a disease re- 
sembles the venereal in some of its symptoms, but 
not at all in others, then those other symptoms are 
to be set down as the specific or leading ones of the 
disease to which it belongs, the resembling symp- 
toms to the venereal being only the common ones." 
" Other diseases," he says in the same chapter, 
" shall not only resemble the venereal in appear- 
ance, but in the mode of contamination ; proving 
themselves to be poisons, by affecting the part of 
contact ; and from thence producing, not only im- 
mediate consequences similar to buboes, but remote 
consequences similar to the leus venerea."* 

In elucidation of these opinions, Mr. Hunter re- 
lates some cases worth adverting to. The first 
case is that of a gentleman, who inoculated himself 
with the matter of yaws in his finger, while opening 
an abscess in the shoulder of a negro woman. In 
consequence, he was effected with tumours, which 
extended up the arm to the axilla ; nocturnal pains 
in his bones, scabby eruptions in different parts of 
his body, nodes on the tibia, and ulceration of his 
throat. From the beginning he took mercury in 
large quantities, which seemed to have no effect 
upon the disease. 

The next instance is that of a lady, whose milk 
being abundant, and her own child too weak to 
draw her breasts sufficiently, suckled a child, who, 

* Hunter, p. 567. 



'&2 TESTIMONIES OF THEIR EXISTENCE 

it was afterwards discovered, had the thrush, of 
which it died tabid, with many sores on different 
parts of its body. The lady, at first, had several 
small ulcers about the nipples, followed by swelling 
of the axillary glands ; the former healed, and the 
latter subsided in the course of three months. Im- 
mediately afterwards, the patient complained of 
shooting pains in different parts of her body, which 
were succeeded by eruptions on her arms, legs and 
thighs, many of which became ulcers. About two 
years afterwards, she was delivered of another 
child in a diseased state, the cuticle peeling off in 
various parts, and a scabby eruption covering the 
whole body. The child lived but nine weeks. The 
nurse to whom the child had been committed, com- 
plained of headach and sore throat, together with 
ulceration of the breasts; the bones of her nose and 
palate exfoliated, and, in a few months, she also died 
tabid, without having derived any benefit from mer- 
cury, with which she had been salivated. 

On the various remedies tried by the lady her- 
self, among which was mercury in a variety of forms, 
none succeeded so well as sea-bathing, and the 
Lisbon diet-drink, under which treatment the sores 
were healed. 

After having had another child, who died under 
the same symptoms, in the course of a month after 
its birth, the sores broke out again, and although 
internal medicines were given, remained for a 
twelvemonth, when they began to heal. This case 
demonstrates, that poisons are evolved similar to 
the syphilitic in many respects, though not in all. 



INDEPENDENT OF SYPHILITIC INFECTION. 33 

It also evinces, that, notwithstanding the use of 
mercury, they will pursue their course, and that the 
means most capable of removing their effects, are 
those calculated to increase the secretions, and 
strengthen the constitution. Mr. Hunter gives an- 
other remarkable instance in the same chapter, 
which still farther elucidates those principles, but I 
shall refer the reader to his works, as the detail is 
too long to be introduced.* 

The several cases he relates of disease arising 
from transplanted teeth, which, I believe, no one of 
the present day will esteem to be syphilitic, offer 
corroborated evidence of the existence of dis- 
eases which closely resemble syphilis. Ulceration 
of the gum and jaw was the first symptom, and, in 
general, took place a month after the insertion of 
the transplanted tooth ; blotches on the skin, ulcers 
of the tonsils, and nodes on the tibiae succeeded. 
Two of the patients recovered without mercury; in 
others, the constitutional symptoms gave way to 
that medicine, but recurred several times, after the 
most severe courses. 

This is particularly obvious in the third of those 
cases ; the symptoms, we are told, yielded to corrosive 
sublimate, three years after the commencement of the 
attack, and Mr, Hunter remarks, " all who seemed 
to be cured by mercury, had not a treatment simi- 
lar to those who are indisputably poxed." Mr. 
Hunter was of opinion, that not one of the persons 
from whom the teeth were taken, had the leus ve- 

* See Hunter, p. 578, et seq. 
£ 



34 TESTIMONIES OF THEIR EXISTENCE 

nerea. "When we consider that the girls from 
whom the teeth were taken, had not the least ap- 
pearance of disease at the time, and had none when 
the disease broke out in the person who received 
the teeth, it becomes strange that it should break 
out in the receiver, and not in the giver. " For," 
he says in another place, " I consider it impossible 
for parts to have the power of contaminating, which 
are not themselves diseased; and, in these cases, 
the parts contaminating were never known to have 
been contaminated themselves. 

" If it were asked, what is this disease, thepe 
would be more difficulty in answering what it is 
than what it is not. I should say, that a sound tooth 
transplanted, may occasion such an irritation as 
shall produce a species of disease, which may be 
followed by the local complaints above mentioned, 
and that undescribed diseases, resembling the vene- 
real, are very numerous; and what I have said, is 
rather to be considered as hints for others to prose- 
cute this inquiry farther, than as a complete account 
of the subject.'^'' 

This inquiry, which Mr. Hunter so happily com- 
menced, has been followed by Doctor Adams and 
Mr. Abernethy. These gentlemen, after a farther 
pursuit of the subject, are of opinion, that not only 
a certain modification of animal matter, being ap- 
plied to a susceptible surface of the body, will ex- 
cite an ulcerative disease, but that the healthy se- 
cretions of one animal, when applied to a crude 
wound, or denuded surface of another, will also ex- 
cite ulceration, of which Mr. Hunter's cases of 



INDEPENDENT OP SYPHILITIC INFECTION. 3 J 

transplanted teeth, afford strong evidence ; and 
that the ulcer thus formed, is capable of produc- 
ing constitutional affections, which bear a resem- 
blance to those of syphilis. Mr. Abernethy details 
several cases in support of this opinion, from which 
I shall select the first and third, as they are very 
brief, and elucidate sufficiently the subject under 
consideration. 

Case I. — "A gentleman was connected with a fe- 
male who was kept by another gentleman, and de- 
rived, from such connexion, several very irritable 
and foul sores, which broke out on the prepuce, but 
which, however, had not the syphilitic characters^ 
As neither the woman nor her keeper had any dis- 
ease, he had no wish to take mercury, nor had I, 
being consulted on his case, any desire to recom- 
mend it to him. The sores did not heal until be- 
tween two and three months, though a variety of 
local applications were employed. He at length, 
however, became perfectly well, and I cautioned 
him not be again connected with the same woman. 
But his inclination got the better of his prudence, 
and another crop of sores, equally irritable, foul, and 
tedious, took place, in consequence of a second con- 
nexion. These sores were treated in the same 
manner as before, and slowly healed. After some 
lapse of time he again erred in the same manner; 
and again received the same punishment. He had 
no constitutional disease from these sores." 

Case HI. — "A gentleman, lately married, com- 
plained to his surgeon of a running from the ure- 
thra, which so strikingly resembled a venereal go- 



36 GENERAL OBSERVATIONS. 

iiorrlioea, that the latter could not but ascribe it to 
infection. He had afterwards a swelling of the 
prepuce, and sores on that part, which confirmed 
the surgeon in his opinion, and produced a kind of 
dissention between his patient and him ; the one 
affirming that the disease was venereal, the other, 
that it could not possibly be so, as his wife had no 
disease, and he had connexion with no other wo- 
man. The effect of this litigation was, that the 
surgeon would not urge the taking of mercury; nor 
would the patient require the administration of that 
medicine, though a bubo, sore throat, and eruptions 
succeeded ; which could not be distinguished from 
similar complaints of a syphilitic nature, but all of 
which spontaneously got well." 

Having, as I conceive, adduced sufficient evidence 
to prove, that ulcers on the generative organs, were 
at all times common before there was, in this part 
of the world, any acquaintance with syphilis ; and 
that these ulcers were frequently followed by con- 
stitutional disorders ; we must acknowledge the ne- 
cessity of discriminating them from those of true 
syphilis, and from each other, and not condemn all 
however unlike, to a similar mode of treatment be- 
cause they happen to be found on the same parts, 
and are produced by the same kind of communica- 
tion. We miorht, with as much consistency, treat 
all ulcers of the throat alike, whether arising from 
scrofula, scarlatina, or simple inflammation; yet, 
strange to tell, at this improved period of surgery, 
and notwithstanding the valuable observations of 



GENERAL OBSERVATIONS. 37 

Mr. Hunter, Mr. Abernethy, and Dr. Adams, it is 
too generally the practice to treat every ulcer on 
the genitals as syphilitic, whatever may be its ap- 
pearance, character, or distinction.* 



* Notwithstanding the ingenious arguments adduced by the au- 
thor in this chapter, there is still reason to believe him essential- 
ly wrong in his principal conclusions. Circumstances of a very 
decisive nature, lead to a belief in the identity of the source, as 
well as the great antiquity of all the forms of syphilis, and the con- 
sequent overthrow of the original title so long urged in favour of 
America. That all the forms of syphilis are as ancient as the 
custom of promiscuous intercourse between the sexes, is by far 
the most probable conclusion. Contrary to the general opinion, 
which admits this disease to be communicated and disseminated 
only by infection from one person to another, there is perhaps no 
medical fact better established than that it is likewise spontane- 
ously generated by promiscuous venery. Our limits, however, 
will not admit of the proofs and arguments which might be ad- 
duced in favour of these positions. E. 



CHAPTER II. 

GENEILiL OBSER VATIONSON VENEREAL DISEASE S.-THEIR 
SPECIFIC DISTINCTIONS^ AND APPROPRIATE MODE OP 
TREATMENT. 

Since the first edition of this work was published 
in 1814, the treatment of venereal diseases without 
mercury, has been extensively tried, not only in 
Great Britain, but in all parts of the civilized world 
which have been visited by British troops. 

The office of the Army Medical Board is, I un- 
derstand, piled with volumes of reports on the non- 
mercurial mode of treatment ; and we have every 
reason to expect that a digest of this extensive mass 
of papers will be published, under the auspices of 
the gentleman who so ably presides over the army 
medical establishment. I do not pretend to antici- 
pate the precise conclusions which such a digest 
w^ill afford ; but this much I believe I may venture 
to assert, that ample experience has been afforded 
to prove, that every form and stage of venereal 
disease are capable of being cured without the aid 
of mercury; and that nodes and affections of the 
deeper seated parts seldom or never occur in those 
cases where mercury has not been employed. 

The cure, in those cases non-mercurially treated^ 
has been conducted chiefly by the aid of rest, 
cleanliness, astringent applications, antimonials, sar- 



GENERAL OBSERVATIONS, &C. 39 

saparilla, and the antiphlogistic regimen. Collec- 
tively considered, recovery, it is thought, has been, 
in the cases thus treated, more slowly effected than 
when mercury has been employed. But even with 
this drawback, how important to medical science is 
a knowledge of the fact, contrary to all preconceived 
notions, that the venereal disease, in all its forms 
and stages, admits of being cured without the aid 
of mercury: — a medicine which, when employed 
with propriety, is one of the most useful and pow- 
erful instruments in the hands of the profession, 
but, when misapplied, is equally capable of produc- 
ing the most baneful and destructive effects. Even 
those who still continue to consider mercury as the 
only specific (as they term it) for the cure of ve- 
nereal diseases, may now fearlessly w^ithhold it in 
those cases, where a consumptive tendency, or a 
morbid state of the constitution, would render its 
exhibition dangerous to the life of the patient; and 
even, if nothing more than this had been gained by 
the investigation of the last ten years, the benefit 
which it has conferred on mankind has been of no 
trifling importance. This will be allowed when 
we consider the multitudes, who were, previously 
to this investigation, and the numbers who still are, 
doomed to undergo for the slightest venereal affec- 
tion, or even suspicion of such an affection, a regu- 
lar course of six or eight weeks of that powerful 
mineral ; under the superintendence, not always of 
the well-informed, but frequently of the most gross- 
ly ignorant pretenders to the profession. 

I have said above, that the non-mercurial mode 



40 GENERAL OBSERVATIONS ON 

of treatment in the cases, collectively considered, 
has been more slow in effecting a cure, than where 
mercury has been employed ; but if we withhold 
that medicine when its employment may be dis- 
pensed with as useless, or avoided as dangerous, 
and if we have recourse to it when its adoption is 
likely to be attended with advantage, 1 shall ven- 
ture to assert that the cure in all cases, collectively 
considered, will not only be far more certain, but 
by many degrees more rapid than by following 
either of the sweeping systems of exhibiting or 
withholding mercury in every case. 

If I were obliged to follow either system ex- 
clusively, for which I see no possible necessity, I 
should certainly prefer the non-mercurial plan of 
treatment, as that which is fraught with far less 
dangerous consequences. 

Mr. Chevalier, in his excellent little work on gun- 
shot wounds, has shrewdly observed, on the prac- 
tice which prevailed at the time of his publication, 
of dilating every gun-shot wound, that " it seems 
absurd to make the rule to dilate so very absolute, 
that a man must inevitably be cut, because he has 
had the misfortune to be shot." An observation 
somewhat similar, may be applied to the venereal 
sufferer, who may well complain that it is a suffi- 
cient misfortune to be disordered, without being 
dosed to death, by a remedy that is worse than the 
disease. 

Mr, Chevalier sees nothing of obscurity in a gun- 
shot wound, which ought to prevent us from treat- 
ing it according to the general principles of surgery 



VENEREAL DISEASES. 41 

applicable to contused and lacerated wounds ; and, 
therefore, restricts the use of the knife to the at- 
tainment of a precise object ; such as the extraction 
of an extraneous body, the suppression of haemor- 
rhage, or the division of a constricting fascia. And, 
on the same principles, let us restrict the exhibition 
of mercury to a precise object ; such as the general 
principles of medical science would authorize, for 
the cure of the symptoms of a morbid poison with- 
out considering mercury as a specific, or the dis- 
ease for which it is administered incomprehensible, 
and therefore only a fit object for blind empirical 
practice.* 

We have been long taught to believe that mer- 
cury was the only remedy for every form of vene- 
real disorder, gonorrhoea excepted. It was, there- 
fore, high time to commence an investigation into 
the most suitable mode of treating venereal diseases, 
when every practitioner, even of very limited expe- 

* The doctrine and practice here inculcated, may be regarded 
as a fulfilment of the prediction of the late Professor Rush, who, 
in his lectures, asserted it as his belief that the time would come 
when syphilis, like other diseases, would be treated upon general 
principles. 

It was formerly the case, nay, among some of our respectable 
physicians the practice still prevails, that every person with sores 
on the genitals following a suspicious connexion, was immediate- 
ly put under a mercurial course, without any regard to the na- 
ture or appearance of the primary ulcers. If the affection did 
not get well, or what was very commonly the case, became worse, 
it was considered as an evidence that enough mercury had not 
been used. The rubbings and the pills, the washes and fumiga- 
tions were consequently increased with diligence, and when all 
the evils were found to be aggravated, and the miserable patient 
died, or suffered mutilation, his fate was regarded as an incontes- 
table proof that he had not received enough mercury into his 
f=yst^m. E, 



42 GENERAL OBSERVATIONS ON 

rience, must have met with circumstances to shake 
his faith in the powers of the remedy, from perplex- 
ing embarrassments and inextricable difficulties ac- 
cumulating upon him, as long as he persisted in the 
exhibition of his specific,^ 

But in order to preserve our faith unshaken, in- 
genious devices have been, from time to time, saga- 
ciously resorted to. By one of these we learned, 
that not only the new symptoms which arose under 
the most severe courses of mercury, but even the 
old ones which resisted its influence, were attribu- 
table to the remedy, and not to the disease. Hence 
we have descriptions of mercurial chancres, mer- 
curial ulcers, pains, nodes and swellings of the lym- 
phatic glands of the neck. But in ascribing those 
symptoms to mercury, we have entirely overlooked 
this obvious circumstance, that that medicine, when 
exhibited even to profusion for liver, or any disease 
which is not venereal, has never in any one instance 
produced those effects. 

With respect to the deteriorating influence of mer- 
cury, I am perfectly willing to allow that when it 
does not altogether supersede the actions of a mor- 
bid poison, it may so far alter or modify its symp- 

^ In excepting gonorrhoea from the forms of the venereal dis- 
ease, for the treatment of which we have been taught to beUeve 
mercury unnecessary, our author has, perhaps, forgotten that even 
in this complaint some of our most able and orthodox medical au- 
thors, have inculcated the necessity of a mercurial course. Sy- 
denham Rotherham, in his Notes to Cullen's Practice, and even 
the popular and modern work of Thomas, recommend mercurials 
as the only means to be trusted for its radical cure. Such re- 
commendations are w6ll calculated to extend the evils ascribed 
to mercury, by leading to its unnecessary employment. E. 



VENEllEAL DISEASES. 43 

toms, as to change, in a great measure, the appear- 
ance and natural progress of the disease ; but this 
is essentially different from an admission, that the 
remedy will produce symptoms which can scarcely 
be distinguished from those of the poison itself. 

Another device common to many arts and sci- 
ences, besides surgery, is an endeavour to conceal 
our ignorance, by the adoption of plausible and de- 
lusive epithets and appellations. The term syphi- 
loidal I cannot but regard in this point of view. It 
is usually applied to those symptoms, which con- 
tinue to linger after the patient has undergone full 
and repeated courses of mercury, and which that 
medicine was found incapable of curing. Those, 
therefore, who looked upon mercury as a certain 
cure for every form of venereal disease, found it ne- 
cessary to give those unaccommodating symptoms 
a name ; they therefore called them syphiloidal ; 
which, if it means any thing, insinuates that some- 
thing is present which resembles or appertains to 
syphilis, and which is not syphilitic. The coinage 
of this name, however, gave them an opportunity of 
relinquishing the further use of mercury, without 
making the mortifying acknowledgment, that they 
had been using, to a dangerous extent, a medicine 
incapable of curing the disease for which it w^as ex- 
hibited. These subterfuges were, however, useful, 
and, I will even say, reflected some credit upon those 
who devise them, as they obviated the injurious 
perseverance in the use of the medicine, which 
might otherwise have been considered a matter of 
necessity. 



44 GENERAL OBSERVATIONS OiV 

Since, however, it is now well known, that cer- 
tain forms of venereal disease will pursue their 
course, whether mercury is employed or not, it is 
absurd any longer to retain words in our vocabula- 
ry which are calculated to mislead us from the 
truth. Nothing I am certain, would tend more to 
promote the present investigation, and the attain- 
ment of a perfect knowledge of venereal diseases, 
than to drop altogether those common, but arbitra- 
ry, terms syphilitic, syphiloidal, and pseudo-syphi- 
litic ; even the term mercurial should be restricted 
to designate those phenomena onl}^ which are 
known to arise from the use of mercury in other 
diseases besides the venereal, by which means we 
avoid the perplexity of confounding the symptoms 
arising from the poison w^ith the effects of the re- 
medy. 

In place of those arbitrary names which mean 
nothing, if surgeons would confine themselves mere- 
ly to terms descriptive of appearances and symp- 
toms, language would not be wanting to convey an 
adequate notion of any class of diseases. I have 
attempted,! trust, with some success, the adoption of 
this simple and natural mode of distinguishing vene- 
real diseases ; but though I by no means have the 
presumption to fancy that I have completed this dif- 
ficult task, yet I have met with very few cases which 
would not naturally fall under one or other of the 
classes I had formed. 

The difference which was found to exist in the 
appearance and progress of certain groups of symp- 
toms which usually went together, compelled me to 



VENEREAL DISEASES. 45 

presume the existence of a plurality of venereal poi- 
sons ; but whether this opinion is right or wrong, 
can not, in a practical point of view, be of any con- 
sequence, if we confine ourselves to the more sim- 
ple inquiry into the circumstances and symptoms, 
for which mercury ought or ought not to be exhi- 
bited. These are questions purely practical, and 
to which I profess more particularly to confine my 
attention in the following Essay. 

But before I enter upon this task, I must observe, 
that I have not yet heard a satisfactory objection 
from those, who restrict their belief to the exist- 
ence of a single venereal poison, against the histo- 
ric evidence detailed by a multiplicity of authors, 
testifying that infectious venereal diseases existed 
at all times previous to the introduction of syphilis, 
towards the close of the 15th century. Are we to 
suppose that those old venereal poisons either sud- 
denly disappeared by one common consent, or were 
actually superseded by the introduction of the new 
one ? an opinion sufficiently refuted by the variety 
of characters exhibited in primary ulcers and vene- 
real eruptions ; the latter so numerous as to afford 
specimens of almost all the different orders of cu- 
taneous diseases. If we were to admit but one ve- 
nereal poison, we must conclude, that the regularity 
of the progress, and uniformity of the symptoms, 
which are observed in all other morbid poisons, do 
not appertain to this, and this alone ; thus making 
an unreasonable and unwarranted exception to a 
universal law of nature. But stiil this is met by 
another subterfuge not so easily answered, and the 



46 GENERAL OBSERVATIONS ON 

difference of venereal appearances is ascribed to a 
difference in the constitution of patients. But 
whether the variety is owing to a diversity of poi- 
sons or a diversity of constitutions, is a question 
that can only be resolved b}^ a series of experi- 
ments, which it is not to be expected that any man 
will be so public spirited, as to submit to himself, 
or so unreasonable as to inflict upon others. 

If it were possible to guard against abuses, and 
were not contrary to the spirit of our laws, it would 
greatly tend to the advantage of society if criminals 
were sometimes permitted to commute a heavier 
punishment, by submitting to a series of experi- 
ments, for the purpose of ascertaining the truth in 
such questions as the present. 

I am perfectly aware, how much the state of the 
human constitution will modify local diseases ; and 
am willing to attribute, to a certain extent, the 
great variety of appearances we witness daily in 
venereal complaints, to this cause alone. But yet 
we observe that many of those primary ulcers 
evince from their very commencement such pecu- 
liar and distinct characters, that it would be quite 
an absurdity to believe that the virus is always the 
same, and the variety of characters dependent alone 
upon constitution. 

Thus nothing can be more opposite, even from 
the commencement, than the common chancre with 
its hardened base, like a piece of cartilage under 
the skin, and the sloughing ulcer. The first is slow 
and chronic ; the latter begins with a mortified spot, 
extends by alternate sloughing and phagedenic ul- 



VENEREAL DISEASES. 47 

ceratioii, and often makes more progress in three 
days than the former in as many weeks. 

The phagedenic ulcer is equally distinct from 
chancre, as it does not evince, at any period, a hard- 
ened base, but gradually creeps from one part to 
another of the penis, leaving those parts to heal, 
which in the first instance it attacked. So that 
when the disease has existed for some months, the 
glans is seen to exhibit its entire surface furrowed 
over with ulcerations and cicatrices. 

There is a raised ulcer, also, with elevated edges, 
approaching the nature of the phagedenic ulcer, 
yet whose characters are sufficiently distinct to be 
considered as a separate species. But the most 
common venereal primary ulceration commences 
as a pustule, is excavated in the first week, and in 
the second becomes raised above the surrounding 
integuments, exhibiting a smooth fungous surface ; 
it may also be described by its negative qualities, 
and as an ulcer without induration, raised edges, or 
phagedenic surface. 

If the plurality of venereal poisons is supported 
by the variety of primary ulcers, it is more so by 
the multiplicity of constitutional eruptions. A pri- 
mary ulcer, which was not phagedenic or sloughing 
at first, may afterwards, like any other ulcer, become 
so by irritation, neglect, or inflammation. But I do 
not conceive that we have grounds for supposing 
that the state of the constitution can so modify 
morbid poisons, as to cause the same virus to pro- 
duce in one person the chronic scaly lepra, and 
psoriasis, and to assume in another a decided pus- 



48 GENERAL OBSERVATIONS ON 

tular form, each pustule spreading rapidly into a 
deep ulcer. 

These two kinds of eruption may serve to illus- 
trate the subject, as in their nature they are so 
directly at variance. But I would be inclined to 
admit, that an eruption of papulae with acuminated 
heads containing matter, and approaching the pus- 
tular form, might be so affected by the constitution, 
as not to be distinguishable from the most regular 
pustules. The character of the disease may, how- 
ever, still be apparent, as their pustules, instead of 
spreading into extensive ulcers, will, like papulae, 
terminate in desquamation, but the scales will be 
larger; and in addition to this circumstance, the 
pustules will, throughout, be intermingled with 
papulae. These circumstances may serve to distin- 
guish, in doubtful cases, the form of disease, which 
is attended by the venereal lichen or papular erup- 
tion, from that which is much more formidable, and 
produces pustules which terminate in ulcers. 

This view may conduce to satisfy us, that the 
powers of the constitution are much more restrict- 
ed in modifying the symptoms of a morbid poison 
than is supposed by those who adhere to the gene- 
ral opinion, that the same virus may produce in one 
person the scaly lepra; in another, papulae that ter- 
minate in desquamation ; in a third, pustules, the 
precursors of malignant ulcers; and in a fourth, 
tubercles, — exhibiting a diversity, which does not 
occur in the eruptions of small-pox, measles, scar- 
latina, -and other morbid poisons — at the same time. 



VENEREAL DISEASES. 49 

forgetting that all are equally subjected to the in- 
fluence of the constitution. 

From an attentive consideration of a vast num- 
ber of cases during many years, I find strong grounds 
for concluding, 

First. — That the syphilitic chancre is attended 
by the scaly eruptions, lepra and psoriasis, an ex- 
cavated ulcer, of the tonsils, and pains and nodes of 
the bones. 

Second. — That the simple ulcer, without indura- 
tion, raised edges or phagedenic surface, — gonor- 
rhoea virulenta, and excoriation of the glans and 
prepuce, are followed by a papular eruption, which 
ends in desquamation, pains in the joints resembling 
those of rheumatism, soreness of the fauces, and 
frequently swelling of the lymphatic glands of the 
neck; but that in a vast number, not a single in- 
stance was observed, in w^hich nodes were an at- 
tendant upon this eruption.* 

Third, — That the ulcer with elevated edges, in 
the few instances in which I had an opportunity of 
tracing it to its constitutional symptoms, was fol- 
lowed by a pustular eruption, which terminated in 



* In one instance of the papular eruption, in which there was 
considerable inflammation of the ankle, an appearance suddenly 
took place on the tibia, immediately above the inllamed joint, 
which at the time 1 considered as a node ; but as it afterwards 
disappeared with the inflammation of the joint, without the exhi- 
bition of mercury or any particular attentions, and as I have not 
from that period, eleven years since, witnessed any instance of 
node in the papular disease, I am certain that I was wrong in 
calling the appearance in question a node, and therefore feel my- 
self warranted in making the unqualified assertion on the subject, 
contained in the text. 



50 GENERAL OBSERVATIONS ON 

mild ulcers, pains in the joints, and ulcers in the 
throat, but no appearance of nodes ; yet that the 
instances in which I had an opportunity of witness- 
ing distinctly the connexion between the primary 
and secondary symptoms of this poison, were too 
few to form a decided conclusion with respect to 
this particular. 

Fourth. — That the phagedenic and sloughing 
ulcers are generally attended by constitutional 
symptoms of peculiar obstinacy and malignancy, 
viz. pustular spots and tubercles, which formed 
ulcers that spread in general with a phagedenic 
edge and heal from the centre; extensive ulceration 
of the fauces, particularly of the back of the pha- 
rynx, obstinate pains of the knees and other joints, 
while nodes are frequently present, and the bones 
of the nose are occasionally affected. 

Fifth and last. — That, when an eruption, no 
matter what its character mav be, is on a surface 
which is opposed by another, as on the fossa of the 
nates, upper part of the inside of the thighs, or in 
the axilla, the spots, if they do not ulcerate, extend 
into soft, moist elevations of the cutis, which ought 
to be treated according to the nature of the disease 
to which they belong. Thus, if they are syphilitic, 
with mercury : or, if papular, pustular, or tubercu- 
lar, with the remedies recommended for the speci- 
fic disorder. According to the established practice, 
these condylomatous swellings, as they are called, 
are universally treated with mercury ; but I have, 
in innumerable instances, eured them, and the other 



VENEREAL DISEASES. 51 

symptoms with which they are accompanied, with- 
out the exhibition of a particle of that medicine. 

These conclusions, it must be expected, will be 
doubted or denied by many who may possibly aver 
that they have seen a great variety of venereal ul- 
cers and eruptions, but have never observed the 
coincidence or correspondence here stated. I would 
ask, did they ever examine patients, when affected 
with primary and secondary symptoms, with a view 
to discover a correspondence between the one and 
the other ? — have they not, on the contrary, always 
been impressed with the belief that all venereal 
symptoms, however various or opposite their cha- 
racters, have sprung from one identical poison ; and 
that constitutional differences have alone produced 
this variety of character in the symptoms ; and witli 
such an impression on their minds, is it not natural 
to suppose, that they would scarcely examine the 
primary and constitutional symptoms with the same 
acumen as a practitioner who doubted the truth of 
the established doctrine ? 

But if an investigation surrounded by so many 
perplexing difficulties, is not carried on in the spirit 
of candour by persons more anxious to obtain truth 
than victory, we are not likely to make much use- 
ful progress. With regard to such an investigation, 
let it be recollected that, in any sore whatever, the 
various causes of irritation will considerably alter 
its appearance from its original or natural state ; 
and, therefore, that it must be difficult to decide 
upon the character of an ulcer arising from a mor- 
bid poison until rest and appropriate attentions have 



D'J, GENERAL OBSERVATIONS ON 

removed all extraneous irritation. Let it also be 
kept in view, that frequently a person will have on 
him at the same time the symptoms arising from 
more than one infection. If, therefore, primary and 
secondary symptoms exist together, before we de- 
termine in our minds that they stand in the relation 
to each other as cause and effect, let us enquire if 
the primary symptoms did not appear after the se- 
condary, or so near to each other in point of time 
that one could not be the occasion of the other. 
iVnd let us also recollect, that, although a phagede- 
nic ulcer in general spreads extensively, yet that 
it is capable of healing soon after its commence- 
ment, if not irritated by mercur}^ or other causes ; 
and that, therefore, a superficial observer may be led 
to ascribe the obstinate and malignant constitution- 
al symptoms which this ulcer occasions to a prima- 
ry ulcer of a very different character. 

These observations ma}' induce the rising gene- 
ration of surgeons to look with more attention into 
the characters of both primary and secondary symp- 
toms than is at present probably practised. The 
utility of doing so T have most ampl}^ experienced ; 
and I v/ill venture to assert that, after a little atten- 
tion and practice, there are few venereal cases, 
tlie result of which may not be prognosticated with 
as much accuracy as that of any other morbid poi- 
son to which the human body is liable. 

The attention which has, of late years, been 
given to the distinctive characters of cutaneous dis- 
eases, enables us to discriminate and describe, in the 
accurate language of Willan, the various eruptions 
wliich arise from venereal poisons : and this is an 



VENEREAL DISEASES. 53 

advantage that our predecessors did not possess, 
and the want of which must have been a great im- 
pediment to the progress of the inquiry, and parti- 
cularly to the advances it would have made in the 
hands of such a man as Hunter. 

Before my observations on this intricate subject 
were submitted to the public, all venereal eruptions 
were described under the vague terms of copper- 
coloured blotches, scabb}^ spots, and other names 
equally equivocal and unsatisfactory with respect 
to their character. But a change for the better 
has already taken place, and in our late publica- 
tions on the subject, these eruptions are described 
in the exact and descriptive nomenclature of Willan. 
Great improvements are, however, still to be made, 
and among others, I would suggest the absolute 
necessity of observing with attention, w hether the 
scaly eruption (for instance) has been scaly from 
the commencement, as in the psoriasis and lepra 
syphilitia, or only in its declining, or desquamating 
stages, as is the case in the papular eruptions, — a 
circumstance which accurately distinguishes one 
from the other. 

f have in different publications brought forward 
sufficient evidence, that all primary ulcers, with the 
exception of chancre, will heal without the exhibi- 
tion of mercury. We learn from the testimony of 
Messrs. Rose, Guthrie, Thompson, and Hennen, that 
even this ulcer will also heal without its influence.* 



* This fact being now well established, the great criterion of 
Mr. Hunter, Mr. Abernethy and all others who believed in the 
constant progression and never retrogression of the symptoms of 
syphilis, unless checked by mercury, falls to the ground. E. 



54 GENERAL OBSERVATIONS ON 

So that according to them, it would appear actual- 
ly unnecessary to exhibit mercury for primar}^ ul- 
cers, except with the view of protecting the consti- 
tution against the accession of secondary symptoms. 
On the point, however, whether or not mercury pos- 
sesses this power, there is a considerable diversity 
of opinion. In a question of this kind, reasoning 
can have no influence ; we must draw our conclu- 
sions from facts, and as yet we have not a sufficient 
number to decide upon. In Portugal, Italy, and the 
southern parts of Europe, Mr. Guthrie informs us, 
mercury is never etpployed for primary ulcers ; and 
I was informed by my late friend. Doctor Armstrong, 
who resided in Vienna for many years, and was 
well acquainted with the practice of the most emi- 
nent physicians and surgeons of that city, that they 
never give mercury for primary ulcers, from a 
knowledge that they will heal without it, and from 
a belief that it will not prevent the accession of 
constitutional symptoms. 

This important question must, however, remain 
undecided, until we have more evidence, upon 
which to form our judgment, but could, no doubt, 
be now satisfactorily answered by reference to the 
multitude of reports on the subject of venereal com- 
plaints filed in the office of the Army Medical 
Board ; particularly to those of Doctor Thompson, 
who, I understand, has not for several years given a 
grain of mercury for venereal complaints in the 
Military Infirmary of Edinburgh.* 

* To this testimony, from abroad, the editor is happy in having 
it in his power to add, that similar experiments made by American 
physicians have been attended with similar results. In Philadel- 
phia, the non-mercurial practice has been tried extensively by 



VENEREAL DISEASES. Db 

The question can only be settled by reference to 
the experience of many; that of an individual, how- 
ever extensive his practice, ought not to decide a 
point of this importance. In the absence, then, of 
documents so much to be wished for, I shall briefly 
state the practice I pursue for primary ulcers ; my 
reasons for adopting it, and the result of my expe- 
rience. 

Being now fully aware, as well from the experi- 
ence of others as from my own, that the true Hun- 
terian chancre will heal without the aid of mercury, 
the propriety may be questioned of exhibiting that 
medicine for its cure ; but it is of so very indolent 
a nature, and ihe surrounding callosity is so very 
slow in dispersing where mercury has not been em- 
ployed, that, notwithstanding my conviction of the 
fact above admitted, I always direct mercury for 
such cases, where there is nothing in the patient's 
constitution to forbid its exhibition, and I continue 
its use as long as the callosity remains. But pri- 
mary ulcers of this character are now so seldom 
met with, that I am not often called upon to direct 

Dr. Thomas Harris, Surgeon in the U. S. Navy. Having charge 
of the Philadelphia Navy Yard Hospital, Dr. Harris possesses an 
opportunity for making such investigations, far more ample and ad- 
vantageous than can be afforded by the range of private practice. 
For nearly six years he has discarded every preparation of mercury 
from his practice, and asserts that he has ever since found all the 
forms of syphilis more tractable, and what is of the utmost impor- 
tance, entirely exempt from secondary symptoms. He further 
declares that he has found that variety of ulcer described as the 
true Hunterian Venereal chancre, yield most readily to the non- 
mercurial treatment. The importance of the subject leads us to 
indulge the hope, that the Doctor will soon favour the public with 
a detailed account of his practice, and the results of his experience. 

E. 



56 GENERAL OBSERVATIONS ON 

it on this account. I never order mercury for the 
primary phagedenic and sloughing ulcers, from the 
nio^t ample experience of the injurious effects of 
that medicine upon them. The pupils every day 
witness instances of mutilated persons applying at 
the doors of the hospital for admission, labouring 
inider ulcers of this description, their teeth dropping 
out of their heads, and their frames emaciated from 
repeated salivations; and I cannot but express my 
astonishment at the pertinacity of those who per- 
severe in a practice, the destructive tendency of 
which must be apparent to every man of experi- 
ence, who does not wilfully shut his eyes upon facts 
that must every day jostle with his prejudices.* 

With respect to all other primary ulcers, I never 
order mercury for them, except they continue long 
obstinate and chronic without showing any disposi- 
tion to heal. In such instances, I usually direct some 
preparation of mercury in alterative doses, watch- 
ing closely its effects on the sore ; and, if found to 
be injurious, instantly discontinuing its use. In 
fact, I administer mercury in such cases with the 
same views of altering the actions of the part, as in 
cases of chronic ill-conditioned ulcers of the leg, or 
any other part of the body. I do not, however, 
commence with mercury in such cases, or think 
of ordering it, except the sores should appear ob- 
stinate after the third or fourth week. 

* The worst picture which can be drawn of the worst form 
and stage of syphilis, cannot equal a sketch which might be made 
of the horrid and not unfrequent consequences produced by the 
improper use of mercurv. E< 



VENEREAL DISEASES. 57 

This plan I have pursued for several years, and 
have not found that constitutional symptoms more 
frequently occur than where full courses of mercu- 
ry had been employed from the commencement; 
and I have always had the gratification of seeing 
my patient recover from his venereal complaints 
with an uninjured constitution. 

From reasoning a priori, it must appear to the 
most ignorant person injudicious to subject a patient 
to a full and debilitating course of mercury, with the 
view of protecting the constitution from the acces- 
sion of secondary symptoms, when we are really ig- 
norant whether or not it possesses such a power. 

But if, notwithstanding every means of precau- 
tion, constitutional symptoms should still make their 
appearance, the practice has been to subject the 
unfortunate patient to a second, or, perhaps, a third 
or fourth course of mercury ; but would it not be in 
such cases a more rational plan of proceeding to 
husband the resources of the constitution, and not 
waste them unnecessarily, until the attack shall 
have occurred, which, though apprehended, may 
never take place ? 

These observations are submitted to the conside- 
ration of inveterate mercurialists, or those who rely 
on nothing but mercury for the cure of venereal 
complaints. As to myself, I should consider it a 
sample of inconsistence and folly, were I to endeav- 
our by mercury to prevent the accession of those 
constitutional symptoms, for which I should not ex- 
hibit that medicine, had they even actually made 
their appearance. The best and surest means, in 



58 GENERAL OBSERVATIONS ON 

iny apprehension, of preventing the accession of 
constitutional symptoms, are those which heal the 
primary sore with as little delay as possible ; and 
thus prevent the secretion of a morbid poison ca- 
pable of contaminating the system. 

In arranging, under distinct heads, the numerous 
appearances and symptoms produced by venereal 
complaints, I would follow the same rule which has 
hitherto guided the judgment of the profession in 
arranging and classifj^ing all other morbid poisons 
attended with eruptions. In other words, I would 
regard the eruption as the most proper basis of 
the arrangement; and, without neglecting such 
auxiliary evidence as other attending symptoms 
may afford, consider them as of minor importance 
in determining the nature of the disease. 

By following this method, it is truly gratifying to 
find how easily the numerous symptoms, both pri- 
mary and constitutional, of venereal diseases, which 
are so various as seemingly to bid defiance to any 
attempt at arrangement, can be disposed of in their 
appropriate places, under the name of the eruption 
which belongs to their respective species.* 

* In a practical point of view, it is of the greatest importance, 
that the physician should be aware of the almost infinite variety 
of appearances which cutaneous aflfections resulting from the ve- 
nereal poison may assume. Attempts to embrace all these varie- 
ties in classifications less extensive than those which include the 
whole range of cutaneous diseases, must, consequently, prove im- 
perfect The editor has seen many cases of the papular, scaly 
tuberculous and other forms, devoid of the usual concomitants 
of syphilis, though evidently produced by the insidious operations 
of that virus. Under these circumstances, it is the duty of the 
practitioner to investigate the case with great attention, in doing 
which, he will often be obliged to extend his inquiries several 
years back. E. 



VENEREAL DISEASES. 59 

Next to the eruption, the symptom most to be 
regarded is the primary ulcer, whose characteristics 
are in general found sufficiently distinct to enable 
us to foretell, with tolerable certainty, what the ap- 
pearance of the eruption will be. But, as observed 
in its place, those primary characters may be de- 
stroyed by irritation, which often produces inflam- 
mation, and not unfrequently sphacelus; and not 
only the distinctive marks of the primary ulcer, but 
of the constitutional eruption, may be so modified 
by the exhibition of mercury, where that medicine 
is improperly employed, as to become altogether 
confused and indiscernible ; unless, indeed, the mani- 
fest ill effects of this mineral shall be esteemed a 
mark of distinction, and is to continue as at present 
the only means of discrimination, while in fact it 
seldom serves as a guide to the practitioner, but by 
leaving the track of its mischiefs behind it. He, 
indeed, discovers his error without finding his road, 
and sometimes blindly, sometimes desperately, 
flounders from mercury to sarsaparilla, and from 
sarsaparilla back to mercury again, without benefit- 
ing his patient or increasing the certainty of his own 
information. 

The affections of the throat are too indistinct to 
afford any certain diagnosis; and in forming our 
opinions, these appearances can only be esteemed 
as auxiliary to the characters of the eruption, and 
of the primary ulcers. But still this minor assist- 
ance is not to be neglected; for instance, the affec- 
tion of the throat which attends the papular eruption, 
and particularly if the disease has not been inter- 



60 GENEtlAL OBSERVATIONS ON 

rupted by mercury, is not an ulcerated, but rather 
an excoriated or erithematous appearance of the 
fauces, very similar to that which attends measles, 
small-pox, or trivial cases of scarlatina. The ton- 
sils are often in this disease considerably swelled, 
as are also the other glands in the neighbourhood of 
the jaws. 

Mr. Hunter has stated, that the excavated ulcer of 
the tonsil is the characteristic appearance of syphi- 
lis in the throat ; but I have found it as frequently 
attended upon the disease which follows the pri- 
mary phagedenic ulcer. Extensive ulcers of the 
pharynx, and ulcers, and caries of the bones of the 
nose are also frequent attendants upon the phage- 
denic primary ulcer; but the same appearances oc- 
cur in those anomalous disorders which arise from 
derangement of the constitution, and are not of ve- 
nereal origin. Wherefore I must repeat, that we 
cannot ground our diagnosis on the appearances of 
ulcers in the throat, when unaccompanied by other 
symptoms. 

With a view to diagnosis, pains are a still more 
equivocal symptom, because in every species of 
venereal disease, they may affect the larger joints, 
and other parts ; but it is useful to know that the 
knees are more frequently subject to this symptom 
in the phagedenic disease, and the shafts of the 
tibiae in syphilis. Still it would be absurd to de- 
duce any conclusion from such circumstances alone. 

Nodes are equally equivocal and uncertain ; for 
syphilis and the phagedenic disease are alike capa- 
ble of producing them. 



VENEREAL DISEASES. 61 

In a former part of this work I have mentioned 
my persuasion, that if all arbitrary terms were dis- 
continued in the nomenclature of venereal ailments, 
and if those alone were adopted in their place, 
which are descriptive of the characters of the dis- 
ease, that this change would in itself be productive 
of the greatest advantages. For as mankind are so 
much guided in their opinions by names, they woidd 
be less liable to be led astray by those which are 
merely descriptive of symptoms and appearances 
which are cognizable by our senses. 

As long as syphilis is the name attached to a 
certain form of vener^eal complaints, we shall never 
escape from the terms pseudo-syphilis, syphiloidal 
symptoms, and sequelae of syphilis. The first is an 
arbitrary term applied to a congeries of symptoms, 
upon the nature and extent of which scarcely two 
practitioners are agreed ; and therefore when one 
person calls a complaint syphilitic, another disease 
altogether different may be presented to the mind 
of the person he addresses. Pseudo-syphilis is 
equally objectionable, as it is too general a term 
for any useful purpose, inasmuch as it embraces 
not only all those venereal complaints which do not 
correspond to Hunter's description of syphilis, but 
also those spontaneous disorders which have no 
pretension to a venereal origin, and are solely at- 
tributable to some derangement of the constitution. 

The terms syphiloidal symptoms, and sequelae 
of syphilis, imply that there is but one venereal 
poison; an opinion which I conceive to be abso- 
lutely refuted, if the facts and arguments contained 



62 GENERAL OBSERVATIONS ON 

in this and my former publications shall be consi- 
dered of any weight. 

Should these observations be thought to present 
sufficient grounds for adopting a radical change in 
the nomenclature of venereal diseases, it may be 
formed on the characters of the eruptions, which 
afford the most certain criterion, by which we are 
enabled to distinguish one species from another. 

Thus, I. That form of venereal disease which 
is the most prevalent of all others, and is attended 
with the papular eruption, may be termed the Pa- 
pular Venereal Disease, II. That which produces 
pustules that terminate in ulcers covered with thin 
crusts, and which heal like common sores from their 
margins — The Pustular Venereal Disease, III. 
That which is attended with spots that have less of 
the pustular character than the preceding class, 
and frequently with tubercles terminating in ulcers 
covered with thick crusts which extend with a pha- 
gedenic margin, and usually heal from their centre, 
may be termed the Phagedenic Venereal Disease, 
a term equally descriptive of the primary as of the 
secondary symptoms. IV. and lastly. That disease 
which I have hitherto distinguished by the name of 
syphilis (but which has been extended by other 
writers to every description of venereal disease, 
although it is probable that every other was known 
in Europe before it) may with much greater advan- 
tage be denominated the Scaly Venereal Disease, 
from the permanent scaly eruption which attends 
it ; and thus may we liberate ourselves from a whole 



VENEREAL DISEASES. 63 

train of prejudices, which follow as the suite of the 
old appellations. 

It may, however, be objected to this classifica- 
tion, that the nature of the disease cannot be known 
until the eruption takes place ; and on a loose com- 
putation it may be regarded that nine cases out of 
ten of primary ulcers are not attended by constitu- 
tional symptoms; so that in a great majority of 
cases the disease has never arrived at the stage to 
which it is indebted for its name. To this objection 
I reply, that the primary ulcers afford a less deci- 
sive means of determining the nature of the disease 
than the secondary; yet from their characters, when 
unaltered by irritation or mercury, we may discrimi- 
nate their nature with sufficient certainty to decide 
on the precise eruption they would produce in their 
secondary state. For instance, 1st, The ulcer with- 
out callosity, raised edges or phagedena, in fact 
without any very peculiar characters, and which 
may, therefore, be termed the simple venereal pri- 
mary ulcer, produces the papular eruption which 
ends in desquamation : and the same effect is pro- 
duced by a patchy excoriation of the glans and pre- 
puce in men, and of the labia and vagina in women, 
and also by a gonorrhoea virulenta. 2nd, The ulcer 
with raised edges produces the pustules which ter- 
minate in small ulcers covered with thin crusts, and 
which heal from their margins, 3d, The phage- 
denic and sloughing ulcers produce the pustular 
spots and tubercles which terminate in ulcers cover- 
ed with thick crusts, which are accompanied with 
phagedena and heal in general from their centre. 



64 GENERAL OBSERVATIONS ON 

4th and lastly, The primary callous ulcer or chancre 
is attended with the well known scaly eruption — 
Lepra or Psoriasis, 

In this concise view of venereal diseases, we 
may perceive that they do not form an exception, 
as is generally imagined, to that uniformity of symp- 
toms and characters which marks the progress of 
all the other morbid poisons with which we are 
acquainted. 

But as the chief object of this work is not to sup- 
port peculiar doctrines, but to afford practical infor- 
mation, if any individual object to the division of 
venereal complaints into four distinct diseases, the 
difference between us is easily reconciled. Instead 
of four distinct diseases, let any one that pleases 
consider them as so many forms or modifications of 
the one disease, each requiring a peculiar mode of 
management, and under this view every practical 
object will be equally well obtained. Therefore, 
as names are of some consequence, let those who 
are of this opinion add the words form of to the 
appellation I have given to each species, and then 
we shall have the papular /orm o/" venereal disease, 
the pustulary form of venereal disease, &c. &c. 
Names and distinctions in nosology are most advan- 
tageous when they also serve the purpose of prac- 
tical utility, and I have little doubt but that it will 
be universally admitted, that the distinctions I have 
made of venereal complaints, formed on the basis 
of the character of the eruption, convey with them 
intimations of the greatest practical utility.^ 

* There is little doubt that those who avail themselves of this 
suggestion of our author will have adopted the most correct deci- 



VENEREAL DISEASES. 65 

The foregoing observations, I trust, have render- 
ed it sufficiently convincing, how much may be 
learned of the nature of our patient's disease by a 
close attention to the character of his symptoms. 
I believe I am not wrong in asserting that practi- 
tioners at present form their decision as to the na- 
ture of the disease, and mode of treatment, chiefly 
from the history of the case. If mercury has alrea- 
dy been used in full courses, the disease is called 
mercurial or syphiloidal, and sarsaparilla is recom- 
mended. If, on the contrary, the patient has as yet 
used none, or but little mercury, the very same 
symptoms are pronounced to be syphilitic, and a 
mercurial course will be directed. 

I would by no means be supposed, by these ob- 
servations, to make light of the advantages to be 
derived from an attentive consideration of the his- 



sion of the question. The well known fact, that a person affect- 
ed with only one variety of the venereal disease, is capable of 
communicating the same or a different form to others, may be con- 
sidered as rendering nugatory our author's arguments in favour 
of a plurality of distinct venereal poisons. During the Peninsular 
war, the British soldiers, who had connexion with the Spanish 
and Portuguese women, contracted a form of disease which was 
comparatively rare among the natives. This was the phagedenic 
and sloughing ulcer, to which the Northern soldiers were proba- 
bly predisposed from change of climate, intemperate habits, and 
other causes, operating upon the constitution, and modifying the 
operation of the original virus, which might have been derived 
from any other species of ulcer. It happily occurs in this in- 
stance that the practical objects are not materially affected by this 
discrepancy of opinion. Notwithstanding the supposed error into 
which Mr. Carmichael has fallen, in describing as distinct diseases, 
what might more properly be regarded as forms or modifications, 
he is certainly entitled to great credit for the nice discrimination 
and accurate delineation which he has displayed in this treatise. 



^6 GENERAL OBSERVATIONS, &C. 

tory of a case, and the effects of mercury upon it ; 
but still I contend that it ought not to engross the 
entire of our attention. The practitioner who forms 
his opinion of a disease, merely from its history, is 
under no necessity of seeing his patient ; he can as 
well determine on the case, if a written statement 
is laid before him. But even few of those who fan- 
cy that all information in venereal cases is to be 
derived from their history, would, I believe, ac^ 
cede to this proposition. I shall in the succeeds 
ing chapters consider each of the forms of venereal 
disease under the appellation which the character 
of its eruption suggests. 



CHAPTER m. 

PAPULAR VENEREAL DISEASE. 

I COMMENCE my particular description of venereal 
complaints with those which are liable to be attend- 
ed with an eruption of papulsB;* because they consti- 
tute the most simple^ most easily cured, and least 
dangerous of all the forms of venereal disease* 

The primary symptoms are either, first, a simple 
ulcer without induration, elevated edges, or phage- 
dena; but whose characters are not very remarkable. 
Secondly, a patchy excoriation of the glans and pre- 
puce, attended with purulent discharge. And, third- 
ly, gonorrhoea virulenta. 

The primary ulcer to whidi I allude^ has neither 
the indurated base which attends the true syphilitic 
chancre, nor the elevated edges which surround the 
primary ulcer of the pustular venereal disease ; noi* 
the phagedenic surface of the primary phagedenic 
ulcer; all of which will be considered in their pro^ 
per places. It is not often the surgeon has an op- 
portunity of seeing this ulcer when at its commence* 
ment ; but in the few instances within my experi- 
ence, it exhibited a small pustule, which continued 
one or two days, on the external prepuce or body 
of the penis ; and then formed a thin crusty which 

'*'See Plate I. figs. 1,2^3. 



68 PAPULAR VENEREAL DISEASE. 

soon separating, exposed an excavated round or oval 
ulcer with a surrounding redness. This in the se- 
cond week began to fill up, and afterwards gradual- 
ly rose above the surrounding skin, exhibiting a 
smooth surface, having the colour of a healthy sore, 
but without granulations, and exhibiting somewhat 
of a fungous appearance. It is in this latter state 
that it usually comes under the observation of the 
surgeon ; and from its mild nature, when compared 
with others, I would propose to name it, the Simple 
Primary Venereal Ulcer. 

The process of ulceration, afs well as the sur- 
rounding redness, seem to cease as soon as the fun- 
gous stage commences, which may exist an indefi- 
nite length of time; but from three to six weeks 
may be mentioned as the averaged period of the 
continuance of this ulcer from its commencement. 

The appearance and duration of this, as of every 
other primary ulcer is liable, of course, to be modi- 
fied by the state of the constitution, mode of living 
of the patient, his exposure to various irritating 
causes, neglect and want of cleanliness. 

These ulcers, which are far more general than 
any others, to which the parts of generation are 
liable, are more frequently found on the glans and 
internal surface of the prepuce than elsewhere, in 
which situation they, in general, excite phymosis ; 
and it is, therefore, extremely probable, that it is 
the identical ulcer mentioned by Celsus,* as induc- 
ing phymosis, and readily cured by lenient reme- 
dies and mild detergent washes. They also occur 

* Celsus, p. 332- 



PAPULAR VENEIIEAL DISEASE. 69 

on the external surface of the prepuce, body of the 
penis, and scrotum, in which last situation they are 
considerably raised above the surrounding surface, 
so as to resemble fungi or soft warts, and are rapid- 
ly cured by an application of a strong solution of 
muriate of mercury, in the proportion of two or 
three grains to an ounce of water. In women, they 
usually occur on the labia, perineum, and fossa of 
the nates. 

When phymosis has taken place, it is difficult or 
impossible to ascertain from what source the dis- 
charge proceeds, whether from these ulcers, or from 
the second primary affection I have mentioned, a 
peculiar excoriation of the glans and prepuce, by 
some called chancrous excoriation, and by others, 
spurious gonorrhoea; or whether the discharge 
flows from the urethra, and is a true gonorrhoea. 
The discharge, however, is frequently occasioned 
by these three affections, at the same time, a cir- 
cumstance which would a priori induce us to sup- 
pose, were there no other reasons for the opinion, 
that they all arise from the same poison ; but this 
supposition is almost confirmed by the fact, that 
the superficial ulcers which we are considering, 
even when situated so far back as the scrotum or 
body of the penis, are, in the majority of cases, ac- 
companied by one or both of the other two affec- 
tions. 

In the excoriation of the glans and internal pre- 
puce, the discharge does not proceed from the en- 
tire surface, but from irregular inflamed excoriated 
patches, leaving interstices of sound cuticle be- 



llO PXVVLAR VENEREAL DISEASE. 

tween ; and I find that Mr. Whately, in his work 
upon gonorrhoea, adduces some facts and arguments 
to prove, that the lining membrane of the urethra 
is affected precisely in the same manner in gonor- 
rhoea virulenta ; and asserts, that he has even been 
able to observe these appearances within the orifice 
of the urethra. He supports his opinions by the 
authority of Doctor Monro, who, in describing in 
his lectures, the manner in which the lining mem- 
brane of the urethra is effected in gonorrhoea, pro- 
ceeds as follows : " The application of the poison 
to the urethra, is seldom equal and universal. There 
is no great comparison between it and the catarrh 
upon the nose, where the membrane is every where 
affected equally ; for here, one part always suffers 
more than another, and it is seldom that we find 
external ulcers, occupying the glans uniformly, but 
it is affected in spots. It is in like manner, the 
same within the urethra, as particular spots of it 
are chiefly affected. We find eschars in few places, 
and an obliteration of certain of the raucous ducts ; 
and the patient, in making water, finds the pain 
more in one place than in another; so we are to 
compare the affection of the membrane of the ure- 
thra to the effects produced on the glans."* 

These observations of Dr. Monro and Mr. Whate- 
ly, on the similarity of appearance in the lining 
membrane of the urethra, and surface of the glans 
and prepuce, when secreting purulent matter, lead 
to an opinion, that the discharge from these sur- 
faces may be produced by the same poison, and is, 
* Wbately on Gonorrhoea, p. 20. 



PAPULAR VENEREAL DISEASE. 71 

therefore, in both instances, the same disease affect- 
ing different parts : an opinion which we would na- 
turally be induced to adopt, on considering that 
both parts have the same continuity of surface, and 
that there exists a great similarity in the affections 
in question. 

From these observations, and from the very fre- 
quent occurrence of two, or even the three affec- 
tions, {viz. the simple primary ulcer, excoriation and 
gonorrhoea,) existing together on the same patient ; 
and from the fact that each occasions the same train 
of constitutional symptoms, we have strong grounds 
for concluding that they arise from the same iden- 
tical poison. 

That the ulcers in question, and excoriation of 
the glans and prepuce described, are frequently 
followed by the papular eruption, every practition- 
er, if his experience be not very limited, must admit; 
but that gonorrhoea alone may also produce it, is 
more questionable. In support, however, of this 
position, I beg to state, that I have repeatedly seen 
men affected with this eruption who asserted posi- 
tively, that they never had any primary symptoms, 
except gonorrhoea ; and I have also, in numerous 
instances seen women effected with the same erup- 
tion, who did not, on the minutest examination, ex^ 
hibit any other primary symptoms than a gonoi^ 
rhcea, and who asserted at the same time that they 
never had primary sores. I at first doubted their 
veracity, or supposed that ulcers might have exist- 
ed on the parts of generation, which had escaped 
their observation 5 but having met innumerable in^ 



72 PAPULAR VENEREAL DISEASE.^ 

stances of the same eruption in persons affected 
with gonorrhoea, combined with a purulent discharge 
from the glans and prepuce, a little consideration 
led me to conclude, that it was the same disease 
affecting different parts. This papular eruption, 
which is occasionally observed to follow gonorrhoea, 
furnished a strong support to those practitioners 
who adopted the opinion, that gonorrhoea and chan- 
cre arise from the same poison. But the facts I 
have stated, and the analogies I have brought for- 
ward, will, I hope, dissipate at least some of the 
doubts and perplexities attending the subject, and, 
perhaps, set at rest this intricate and long disputed 
question. 

Notwithstanding these strong circumstances, it 
must be admitted, that constitutional symptoms 
after a gonorrhoea, is a very rare occurrence ; and 
therefore we can only esteem it as a natural, but 
not a very common consequence. Hunter, who 
supposed that chancre and gonorrhoea arose from 
the same poison, affecting different surfaces, does 
not, as well as I recollect, attempt to explain the 
infrequency of constitutional symptoms attending 
the latter. With the view of affording some clue 
to this hitherto unexplained and little fact, I beg to 
submit the following considerations. 

First. — When we wish to inoculate the matter of 
other morbid poisons, the vaccine and variolous, for 
instance, the earlier it is taken, and while the infec- 
tion is thin, limpid, and not purulent, the more cer- 
tain we are of communicating infection. In the 
latest system of medicine published, that of Dr. 



PAPULAR VENEREAL DISEASE. 73 

Good, we find the following passage concerning 
small pock inoculation : " It is preferable to take 
the fluid before the pustule suppurates^ as afterwards 
it seems to partake of the nature of common pus^ 
and produces a larger circle of inflammation^ and 
on this account also it cannot so fully be relied o?2."* 

The same uncertainty occurs with respect to the 
inoculation of the vaccine virus, if not taken from 
the pustule until the twelfth or thirteenth day, a 
period when the virus has lost its limpid appearance 
and become thick and purulent, when we either fail 
in communicating a disease capable of affecting the 
constitution, or give one of a spurious and impotent 
nature. 

Secondly. — Mucous surfaces, when assailed by 
contagious matter, are excited into a state of inflam- 
mation, which rapidly passes into the suppurative 
stage. 

Thirdly, — It may be inferred from the preceding 
premises, that inflammation and suppuration are the 
bars which nature opposes to the introduction of 
morbid poisons into the system. These views will 
not only account for the infrequency of constitu- 
tional symptoms attending a gonorrhoea, but indicate 
a most important item in the laws which govern 
morbid poisons. It also adds another instance, to the 
many already observed, of a vis medicatrix naturae, or 
of those wise laws of the Creator, by which there ap- 
pears an inherent power in the constitution of ani- 
mals to resist injurious agents. The mucous sur- 

* study of Medicine, by J. M. Good, M. D. Vol. IL p. 636. 

K 



74 PAPULAR VENEREAL DISEASE. 

faces necessarily unprotected by cuticle, are more 
exposed than others to be assailed by a variety of 
morbid poisons ; but they are more promptly than 
other textures excited to inflammation, which rapid- 
ly, and without breach of surface, passes on to the 
suppurative stage, which, from our knowledge of 
the vaccine and variolous inoculation, renders a mor- 
bid poison innocuous. Hence we have strong rea- 
sons, from the above facts and considerations, to 
conclude that the rapidity with which mucous sur- 
faces inflame and suppurate, prevents the admission 
of morbid poisons into the constitution. 

The frequency of catarrh and influenza ma}^ not 
(under these views) be always occasioned by 
changes of atmospherical temperature, but may be 
often owing to contagious matter floating in the air; 
which is thus prevented from doing farther mischief 
than exciting a troublesome affection of the mucous 
membrane of the nares and branches of the bron- 
chial tube. 

Surgeons in the army have opportunities of accu- 
rately investigating the laws of venereal diseases, 
which those in civil life do not possess; as the sol- 
diers are under orders to apply to them on the very 
first appearance of disease, and when cured, or ap- 
parently so, they still remain under surveillance. 
The females who infect a regiment are in general 
known, particularly in foreign stations, and much 
information into the laws of venereal poisons can 
be obtained, by comparing the disease in the fe- 
male with that of the male whom she has infected. 
I, therefore, with pleasure avail myself here of much 



PAPULAR VENEREAL DISEASE. 75 

valuable information contained in the work of Mr. 
Evans, surgeon of the 57th regiment,* which evinces 
in the author much talent for observation, and af- 
fords some important facts that bear upon the ob- 
scure subject under consideration ; and I feel the 
more gratified in thus supporting the opinions I 
venture to offer, by the evidence of others rather 
than my own. 

Mr. Evans details three interesting experiments 
of inoculation of matter, taken at different periods 
from the simple primary ulcer under consideration ; 
which prove that the earlier the infection is taken, 
and while the sore is in its excavated or ulcerating 
state, and, as we may infer, before the matter is 
purulent, the more severe and obstinate is the ulcer 
which it produces. I shall refer to the work itself 
for the detail of the experiments, but the following 
passage contains the result. 

" From these and other experiments, I am inclin* 
ed to the opinion, that in this, as well as in the vac- 
cine disease, the secreted fluid varies, or is less 
certain in its effects in proportion to the duration of 
the disease ; for in the first of these cases, where 
the ulcer from which the matter was taken was of 
ten days' standing, the disease terminated in four- 
teen days ; in the second, where the sore was only 
eight days old, the inoculated disease continued 
eighteen days ; and in the third case, where the 
matter was taken before the cessation of the ulcera- 
tive stage, it continued twenty-eight days." 

* Pathological and Practical Remarks on Ulcerations of the 
Genital Organs, by James Evans, Surgeon of the 57th Regiment, 



76 PAPULAR VENEREAL DISEASE. 

I shall also take the liberty of transcribing from 
Mr. Evans' work the three following cases, which 
decidedly prove that the matter of gonorrhoea is 
capable of producing the primary venereal ulcers 
we have just been considering. 

Case. — " Two gentlemen had connexion with a 
girl, the one shortly after the other; one of them 
contracted venerola vulgaris,* the other gonorrhoea; 
— the girl was examined, she had some discharge 
from the parts, but no ulceration.''^ 

Case. — " A gentleman in the habit of going with 
one particular woman, was occasionally affected with 
discharge from the urethra, sometimes accompanied 
with pain in passing his urine, but more frequently 
not; in the first case it usually remained upon him 
eight or ten days, in the second it generally went 
off in four or five. One day he applied to me for 
advice, under the impression that he had contract- 
ed chancres ; his disease, however, was herpes pre- 
putialis, finely marked, the vesicles being distinct, 
and placed in two parallel lines of three vesicles in 
each. The disease was explained, and the neces- 
sary directions given; he nevertheless, that night, 
paid the lady another visit, and three days after- 
wards came to me, with an ulcer, in the place where 
the herpes preputialis had been, and which turned 
out to be venerola vulgaris. The girl was examin- 
ed; there was some increased secretion^ hut no ul- 
ceration; the disease in him ran its course regular- 
ly in about twenty-eight days. No sooner was he 

* The term which Mr. Evans employs to designate the simple 
primary ulcer described in this chapter. 



PAPULAR VENEREAL DISEASE. 77 

well, than he went again with the same woman, and 
a few days after, had virulent gonorrhoea. The 
woman was again examined, and found free from 
further disease than that degree of increased secre- 
tion^ which may be termed slight leucorrhcea, which 
she acknowledged to have been occasionally subject 
to for six months before. In this case, then, we see 
both venerola vulgaris and gonorrhoea take place in 
the same person from the same cause. 

" Whether or not in some cases ulceration exists 
beyond the reach of the eye, can only be decided 
by examination after death. I must acknowledge, 
no good reason presents itself to point out why it 
should not ; but as we have no proof that venereal 
ulcers do form so far within the vagina, as to be 
beyond discovery, I am no way disposed to argue 
upon the supposition that they do, particularly as 
this is one of the many matters of fact that cannot 
be demonstrated by reasoning." 

Case. — The following appears to me another 

strong case in support of the text. Captain 

contracted gonorrhoea, and a week afterwards em- 
barked for a foreign station. After being at sea for 
six tveeks, the gonorrhoea disappeared, but the next 
day a small ulcer was discovered, which proved 
to be venerola vulgaris : mercury was used, and the 
sore healed, but immediately afterwards another 
made its appearance near the scite of the former; 
it spread over the old cicatrix, and in spite of mer- 
cury, remained open for more than three months. 
In this -: ise, the first ulcer (for I shall take no no- 
t '^ t :^ ecvjiid) must have been the consequence 



78 PAPULAR VENEREAL DISEASE. 

of the application of the gonorrhoea! matter ; for to 
suppose the application of the venerolic poison to 
have been coeval with the gonorrhoeal infection, and 
that it could lie dormant in the part for seven or 
eight weeks, is to go a little too much out of the 
road of common sense, and is contradicted by 
analogy." 

In another part of his work,=* Mr. Evans states 
three cases, in which the males exhibited the same 
description of ulcer on the genitals ; but on examin- 
ing the female from whom the disease was caught, 
no appearance of ulceration, or other disease was ap- 
parent; from which he infers, that these ulcers may 
be caused by " the application of an altered secre- 
tion, without any breach of surface, or discernible 
disease in the female organs." 

I have already, in my first chapter, given Mr. 
Abernethy's opinion, supported by two cases in con- 
firmation of the doctrine, that the secretions of one 
animal applied to the crude surface of another, are 
capable of producing an ulcerative disease ; and in 
further support of this opinion, we are informed by 
Mr. Evans, that he was frequently present at the 
examination of the public women, held at stated 
periods by the French surgeons at Valenciennes ; 
upon which he remarks, " I have always been sur- 
prised at the small portion of disease to be found 
among them : at one which I attended, no less than 
two hundred women of the lowest description, and 
of course, the most frequented by soldiers, were 
examined, and not one case of disease was found 

* Evans, p. 72. 



PAPULAR VENEREAL DISEASE. 79 

among them; nevertheless, the military hospitals 
had, and continued to have, their usual number of 
venereal cases." And in a note he adds, " by vene- 
real' cases, ulcerations are alone meant." 

Mr. Evans might, however, have been in some 
respects deceived, although not one case of disease 
was found amongst them ; as we may presume, that 
on a general inspection of this kind, upon which 
the liberty of following their vocation depended, 
the women were particularly attentive to cleanli- 
ness, and may have removed all appearance of 
gonorrhoea! matter; but ulcers could not have 
been concealed, and no doubt, from the views we 
have taken, if they were affected with gonorrhoea, 
although free from ulceration, they were capable of 
exciting the latter in the males with whom they 
were connected.^ 



* That the various forms of the venereal disease can be com- 
municated by those who have no apparent disease of the genital 
organs, is a well established fact, and affords a strong argument in 
favour of the unity of the venereal poison, as well as the origi- 
nal manner of its production. It is an undeviating law of nature, 
that excesses are always followed with evil consequences. And 
what more suitable retribution could ensue to the unnatural vice 
of excessive and promiscuous copulation than that which attends 
it ? Could it be reasonably sup'posed that a female should have 
frequent intercourse with several men, and experience no incon- 
venience from thus transgressing the most important law of na- 
ture ? A different result might be naturally expected. Organs 
so exquisitely organized, would, from excessive excitement, and 
perhaps, laceration, become highly irritated, and subsequently in- 
flamed, whilst their secretions, converted into foul and acrimo- 
Kiious discharges, would be rendered highly virulent by intermix- 
ture with the most acrid of animal secretions. Inasmuch, therefore, 
as many are seduced into unlawful indulgence by appearances 
of security, it might, perhaps, be useful to society if it were gene- 
rally understood, that however favourable circumstances may seem, 
safety is never to be expected where either of the parties is ad- 
dicted to promiscuous intercourse. E. 



80 PAPULAR VENEREAL DISEASE. 

Notwithstanding the preceding facts and obser- 
vations, which go to prove that the same virus will 
produce the simple primary ulcer described, a j)uru- 
lent discharge from the glans and prepuce, and a 
gonorrhoga virulenta, yet it is not likely that those 
who have formed their opinions respecting venereal 
complaints in the olden time will subscribe to these 
new heresies. Let them, however, recollect that 
the experiments of John Hunter, which go to prove 
that the matter of gonorrhoea will form chancre, 
and that the matter of chancre will reciprocally 
produce gonorrhoea, are directly contradicted by 
those decisive experimeuts detailed by Mr. Benja- 
min Bell, which were instituted by two gentlemen 
in Edinburgh, on their own persons, and witnessed 
bv him and Dr. Duncan. 

In one experiment, the matter of chancre intro- 
duced into the urethra, produced chancre, and in 
the other, the matter of gonorrhoea, placed between 
the"prepiice and glans, produced gonorrhoea of those 
parts, and chance rendered the experiment more 
perfect than was looked for, the matter in the last 
experiment having found access into the urethra, it 
affected it also with gonorrhoea. If these experi- 
ments will not enable us to decide on the fact, ar- 
guments can make but little impression. It is, 
however, too important a question to pass by with- 
out every illustration in our powder to give it. 

Independent of the total dissimilarity in the symp- 
toms, appearance, and progress of gonorrhoea and 
chancre, the following considerations could not but 
have decided our judgment, if they had not been 



PAPULAR VENEREAL DISEASE. 81 

opposed by experiments intended to prove the 
identity of the poison in the two diseases, and which 
were promulgated by the most respectable authori- 

ty- 

It is exceedingly probable, that the matter of go- 
norrhoea introduced between the prepuce and glans, 
will, as in the experiments related by Mr. Bell, pro- 
duce gonorrhoea of these parts, unless, indeed, the 
matter should happen to be applied to a crude or 
abraded surface, and then, most probabl}^, ulceration 
will follow ; for even healthy secretions, applied to 
such a surface, is capable of exciting troublesome 
ulcers. Thus we are furnished with an obvious 
explanation of the mistake of those persons who 
inoculated the glans with the matter of gonorrhoea, 
and asserted that it produced a chancre. 

Gonorrhoea was not described as a symptom of 
syphilis till half a century after its introduction into 
Europe, and after chancre and the other symptoms 
of the disorder had been accurately described by 
the practitioners of the day. At the same time we 
are aware, that a running from the urethra is noticed 
by successive authors, from the earliest periods in 
which we have medical records. But although 
syphilis, immediately after its introduction, was ac- 
curately described, and discriminated from all other 
ulcers and symptoms with which it was liable to be 
confounded, yet, in a few years, all complaints of 
the genitals w^ere indiscriminately confounded to- 
gether and supposed to arise from one and the same 
poison. There is, therefore, no room for surprise, 



82 PAPULAR VENEREAL DISEASE. 

that gonorrhoea should be included in the num- 
ber.* 

In support of the opinion that chancre and go- 
noiThoea arise from distinct poisons, I may observe 
(although I will be accused of begging the ques- 
tion) that the constitutional eruption which follows 
chancre, is of the order of scalr diseases belonging 
to the species lepra, or psoriasis of Willan, while 
that which attends gonorrhoea is papular, belonging 
to the species lichen, of the same author. 

The buboes which occur in this form of venereal 
disease do not exhibit any particular characteristic 
by which they are distinguishable from those which 
arise from other venereal primary ulcers, except 
that they partake of the original mild character of 
the disease. They are. however, probably from this 
cause, often remarkably indolent, occasioning no 
pain and but little inconvenience, except from their 
tediousness. 

The primary symptoms detailed in this chapter, 
are liable to be followed by a papular eruption, 

"^ Astruc is decisive on this point, as may be seen from the fol- 
lowing passage: — "In the fourth period, from 1540 to 1550, se- 
veral of the symptoms, which had shown themselres from the 
tirst eruption of the distemper, seemed daily to abate of their 
violence, such as pustules, srununafa, pains, erosions of the part*. 
&c. : but, on the other hand, there appeared a new symptom to 
make up for this abatement, never observed before, though from 
that time the most common, if not perpetual symptom in the begin- 
ning of the venereal disease. I mean a x'lvulent gonorrhcea. of which 
we have m-ention first made by Brassavolus. in hi? treatise De Ahrbo 
GalUco, which he wrote in l'>51. and published in 1553: by Fer- 
nelius in 1555. lib. 2. de abditis rerum cansis. c^p. 14. and lib. 6. de 
portium morbis el symptomatic, cap. 20. and by Fallopius in cap. 23. 
Tract de Morbo Gallico, which I imagine was written about the 
year 1560." See Astruc, book I. p. 98. 



PAPULAR VENEREAL DISEASE. 83 

which terminates in desquamation. In all the in- 
stances but two which have occurred to me since I 
commenced the investigation, (a period of fifteen 
years,) this has been the case. In these two in- 
stances, which are detailed in p. 99, ct seq. of my 
first edition, the eruption was pustular. I may pos- 
sibly have been mistaken in the characters of the 
primary sores, the exceptions being so few to a 
very general rule. Let this be as it may, it is but 
candid to have them recorded. The utmost any 
individual can do in an investigation of the present 
magnitude, is fairly to state his experience ; for to 
determine the distinctive characters of morbid poi- 
sons, so closely related to each other as those of 
venereal origin, requires a field of observation be- 
yond the scope of any individual, no matter how 
extensive his experience. 

The CONSTITUTIONAL SYMPTOMS of thc papular vene- 
real disease consist of more or less of fever, attend- 
ed with pain in the head, shoulders, and larger 
joints ; and sometimes pain in the chest, with con- 
siderable dyspnoea, which ushers in an eruption that 
chiefly appears on the forehead, chest, and back, but 
also extends in a more scattered way over the ex- 
tremities. 

The fever does not subside on the appearance of 
the eruption, although it is at its height just pre- 
vious to that event. It exists as long as fresh crops 
of the eruption continue successively to appear, and 
is usually accompanied with jiaiiis of the several 
joints, which are most sev^ere at night. 

The papulse vary from a pale red to a deep crim- 



84 PAPULAR VENEREAL DISEASE. 

son, as represented in Plate I. fig. 1, 2, 3. Some of 
them are simply pimples, while others are almost 
advanced to the pustular form. The time of the 
appearance of this eruption after infection is, pro- 
bably, as uncertain as the eruption in the scaly ve- 
nereal disease, or true sjphilis. In a few instances, 
I have observed it to occur in four or five weeks 
after infection. The papulae, in some patients, were 
numerous on every part, but particularly on the face, 
back, and bell}^: in others they were more thinly 
scattered over the surface of the body. They do 
not all make their appearance together, as in the 
eruptions of the exanthemata, but follow each other 
in succession; so that on the same patient some 
spots vAll appear in their commencement like small 
pimples ; others, which have arrived at maturity, 
form larger pimples, with acuminated tops, contain- 
ing pus or lymph : while others, on their decline, 
consist of exfoliations of the cuticle. Their colour, 
in their latter stages, becomes paler, and assumes a 
copper tint, while the exfoliation of the cuticle gives 
an appearance of scaliness, a state in which it is 
most liable to be confounded with the scaly erup- 
tion of sj^philis. But they may be readily distin- 
guished from each other: for when the papular erup- 
tion is on the decline, and has assumed a pale red 
or copper colour, on examining the patient, we shall 
find other spots in their papular or pustular form, 
which will at once point out the character of the 
eruption. But the ver\' appearance of the declining 
papulae will, to a discriminating eye, be sufficient 
for this purpose; for its copper-coloured scaly surface 



PAPULAR VENEREAL DISEASE. 85 

is more raised in the centre than its circumference, 
while the reverse is the case in the scaly leprous 
eruption of syphilis ; as will be more particularly 
insisted on when treating of that eruption. 

In Plate I. fig. 2. is represented a form of the erup- 
tion less frequently met with than the appearances 
delineated in the other two figures. The spots are 
considerably smaller, and at the same time more 
numerous. Few of the papulae have acuminated 
heads containing matter; they are, in fact, minute 
red pimples clustered closely together. In some 
instances, papulae, similar to those delineated in this 
figure, are clustered together in separate patches, 
which are of an irregularly circular form. The pa- 
pulae, as exhibited in those figures, continue a week 
or two before they begin to decline, and two or three 
weeks elapse before the discolouration of the skin 
w^hich they produce entirely disappears. 

In all cutaneous eruptions, attended with any de- 
gree of fever, there is, as Dr. Bateman observes, " a 
general tendency to sore throat, and even to affec- 
tions of the eyes." We need not then be surprised, 
that the disease under consideration should have 
soreness of the throat as one of its most frequent 
constitutional symptoms. It is, however, widely 
different from that which takes place in syphilis, in 
V, hich there is a deep excavated ulceration of the 
tonsils, with little inflammation or difficulty of de- 
glutition. In this disease, on the contrary, the pa- 
tient complains of considerable soreness, and diffi- 
culty of swallowing ; and, on examination, the entire 
fauces, but more particularly the back of the pharynx, 



86 PAPULAR VENEREAL DISEASE. 

exhibit an erithematous appearance, and not unfre- 
quently with considerable swelling of the tonsils, 
which assume, as they always do when swelled, an 
irregular appearance, that is often mistaken for ul- 
ceration. The cervical glands also frequently swell 
and ulcerate in this disease, but more frequently 
when the eruption is on the decline. These swel- 
lings have hitherto been esteemed scrofulous, it be- 
ing supposed, that the patient thus affected had 
scrofula lying latent in the system, which was 
brought into a state of activity b}- the mercury em- 
ployed. 

But this opinion is proved to be untenable by 
the fact, that the patient is equally prone to these 
swellings when mercury is not exhibited as when 
it is. 

This symptom is a common and every day occur- 
rence ; and, in fact, we only recognise in it an analo- 
gous affection to that which often takes place at 
the termination of small pox, measles, scarlatina, 
and all the exanthemata. 

The eruption, after having wholly disappeared, 
will, in some few instances, return again and again, 
at uncertain intervals of from one to several weeks, 
each successive crop, however, being less than the 
former, and attended with less constitutional de- 
rangement. The intervals between those attacks 
are also greater, as the disease exhausts itself, or 
yields to the powers of the constitution. But if the 
progress of the disease has been interrupted by 
mercury, before it has arrived at its latter stages, it 
becomes more obstinate and complicated than it 
would otherwise have been. 



PAPULAR VENEREAL DISEASE. 87 

If that medicine be exhibited on the first appear- 
ance of the eruption, and while there exists consi- 
derable fever, with severe pains of the joints, which 
often demands the use of the lancet, the patient is, 
in general, rendered much worse, his fever is in- 
creased, and the pains become more severe. 

But if the exhibition of mercury is postponed 
until the fever has subsided, the eruption will in 
most instances disappear under its use, and the 
pains, though not removed, will be alleviated. How- 
ever, as soon as the mercurial irritation has ceased, 
a fresh crop of the eruption will, in general, make 
its appearance, together with an increase of pains 
in the joints, and, perhaps, with soreness of the 
throat. 

Under these circumstances, another mercurial 
process is in general recurred to, and the symptoms 
yielding to that medicine, as in the first instance, 
induces a firm belief that the right path has been 
pursued, and that the former failure was owing to 
the employment of an insufficient quantity of mer- 
cury. The patient is, therefore, doomed to a se- 
vere and protracted course of that medicine, and 
while he is under its full influence, the symptoms 
will often return w4th additional severity, to the 
great perplexity of the surgeon, and disappoint- 
ment of the patient. The return of the symptoms 
under these circumstances demonstrates that the 
mercurial irritation on the constitution is no longer 
capable of suspending that of the poison; a fact 
which is probably owing to the effects of habit; for 
the constitution having now become accustomed to 



88 PAPULAR VENEREAL DISEASE. 

the mercurial irritation, no longer feels the same 
impression or is excited to the same actions as for- 
merly, under its influence. 

When the symptoms of the disease re-appear, at 
a time when the mercurial action is at its height, it 
is found to be absurd to persevere any longer in its 
use. It is, therefore, at length discontinued, from 
a belief that the symptoms under which the patient 
labors are not the effects of the poison, but of the 
antidote. He is, therefore, directed to adopt a plan, 
under which he might probably have recovered in 
the first instance. The mercury is discontinued, 
and sarsaparilla, or other vegetable tonics, which, 
without weakening the constitution, promote the 
several secretions, are directed. Under this plan, 
if his constitution has not been irreparably injured 
by the courses of mercury to which it was subject- 
ed, he in general recovers with a rapidity that even 
surprises his medical adviser. 

If the advanced stages of this disease, but parti- 
cularly if the eruptive fever, have been injudicious- 
ly superseded by the early use of mercury, or if the 
eruption has been repelled by imprudent exposure 
to cold, inflammation of the iris of each eye is a very 
common attendant. 

This affection is now so well known, and so accu- 
rately described in all elementary works upon dis- 
eases of the eye, that it is only necessary for me to 
warn my junior brethren to be on their guard 
against an attack that occurs in the most insidious 
manner ; but which rapidly destroys vision, if not 
energetically opposed by appropriate means. 



PAPULAR VENEREAL DISEASE. 89 

Intolerance of light, and defect of vision, are in 
general the first symptoms which induce the pa- 
tient to seek for advice. On examination, a want 
of the usual transparency of the aqueous humour is 
observable, and is caused by a deposition from the 
inflamed vessels of the iris : the pupilar edge of the 
iris at the same time exhibits a thickened and 
puckered appearance, which usually causes an irre- 
gularity in the circular form of the pupil, most ob- 
servable at its upper part. A change of colour may 
be discerned in the iris, on comparing it with that 
of the other eye, if it has not been affected; and 
although the conjunctiva partakes in a slight degree 
of the general inflammation of the eye, yet the ves- 
sels of the schlerotic coat surrounding the cornea 
will be seen obviously enlarged, and deeply engaged 
in the inflammation, which we have no reason to 
suppose is strictly confined to the iris, but extends 
more or less to every part of the eye, as is indeed 
rendered sufficiently obvious by the pain excited 
from pressure on the eye-ball. 

As the disease advances, adhesion takes place be- 
tween the iris and capsule of the lens; the pupil be- 
comes contracted, and portions of lymph not only 
plug up its orifice, but are deposited on the surface 
of the iris. Pus or lymph is seen lying at the bot- 
tom of the anterior chamber, the humours of the 
eye become more opaque, and vision more defec- 
tive. The pain is sometimes intense and lancinat- 
ing, but in general less considerable than might be 
expected from the extent of the disease affecting 
the delicate structure of the eye. Suppuration at 

M 



90 PAPULAR VENEREAL DISEASE. 

length ensues, and the eve becominc: disorojanizeci, 
the matter either makes its way through the scle- 
rotic coat, or transparent cornea, but more frequent- 
ly through the latter. 

In a former publication, I stated that with a sin- 
gle exception, throughout tlie whole of my then ex- 
perience, the eruption if any was present, which ac- 
companied venereal iritis, was papular : and after 
six years' additional experience in attendance upon 
a large hospital, containing wards for the reception 
of venereal patients, as well as for those labouring 
under diseases of the eyes, and also an extensive 
eye dispensary attached to the institution, I have to 
confirm the above statement, by declaring that, 
among the numerous cases of iritis which have been 
during this latter period under my care, there was 
not a single instance of the disease accompanied by 
eruption, in which that eruption was not papular.- 
And yet so guarded am I in my conclusions, that 
with all this experience, I did not, nor do I at pre- 
sent venture to assert, that this venereal affection 
of the eyes is only attendant upon the papular 
eruption. 

This cautious observance, I should think, might 
have protected me from the uncandid observations 
of one of those puny aspirants after fame, who are 
contented to convert, by force of hammering and 
wire-drawing, the solid discoveries of others into an 
ostentatious display of their own tawdry tinsel : thus, 
in this author, the twenty pages of that ever-to-be- 
regretted original writer, John Cunningham Saun- 
ders, the first describer of iritis, are expanded into a 



PAPULAR VENEREAL DISEASE. 9 I 

portlj-sized octavo volume, that does not contain 
one fact of any practical utility, originating in this 
aiitlior's own experience. But the passage in ques- 
tion modestly runs thus : " Some species of erup- 
tion most commonly attends it (iritis.) and is usually 
either of the papular or scaly kind ; we are not, 
however, to credit the statement of a recent specula- 
tive loriter, who would have us believe, that it is 
only joined with the papular, &c." 

Although my name is not brought forward on the 
occasion, yet it is obvious that this sneer is intend- 
ed for me, because it was only from my publications 
that he could have learned that iritis is a common 
attendant upon the papular venereal disease ; a cir- 
cumstance which, with some others of minor impor- 
tance, he has thought proper to borrow from me 
without acknowledging the obligation. I am in- 
clined to believe, however, that the scaly eruption 
he mentions was actually the papular in its declin- 
ing stage ; for the scaly or true syphilitic eruptiop 
has been but seldom met with in this city during 
the last eight or ten years, which probably com- 
prises the space of this author's observations. 

But to return to the other symptoms, I may ob- 
serve that in many hundreds, I might with truth 
say thousands, of cases of this the most common 
form of venereal disease, I have not met with a sin- 
gle instance of decided nodes, or of those affections 
of the deep-seated parts, which are common in 
some of the other forms of venereal complaints ; so 
that the absence of nodes may be considered as one 
of the characters of the papular disease. 



92 PAPULAR VENEREAL DISEASE. 

It must be admitted, that, in a few cases, swell- 
ings occurred over the tibiae, and these might by 
some be denominated nodes. They differed, how- 
ever, from nodes, in possessing much more of the 
inflammatory character, and in effecting obviously 
the integuments covering the bone, and not the 
bone itself, for they appeared suddenly, and after 
continuing a few days as rapidly disappeared with- 
out the exhibition of mercury. 

I have in this outline sketched the leading cha- 
racters of the venereal disease, attended with the 
papular eruption, and have purposely omitted some 
circumstances detailed in my first edition, which 
my increased experience has taught me to consider 
more as accidental occurrences than its usual and 
common attendants. It is not to be expected that 
a writer or lecturer shall detail every appearance 
which may possibly take place in any disease ; all 
that ought to be demanded from him is, that he de- 
scribe the usual and characteristic symptoms which 
are scarcely ever absent, and this I think I have 
accomplished in respect of the form of venereal 
disease under consideration. 

The TREATMENT OF THE PRIMARY SYMPTOMS of the 

papular disease is extremely simple. It consists in 
keeping the patient as quiet as possible ; and if in- 
flammation, with swelling and phymosis should be 
present, strictly confining him to a recumbent posi- 
tion. His diet should under every circumstance be 
very light; but in the latter case the antiphlogistic 
rules ought to be rigidly observed. The internal 
medicines I employ are cathartics, combined with 



PAPULAR VENEREAL DISEASE. 93 

antimonial preparations ; for instance, a couple of 
pills containing equal parts of the compound ex- 
tract of colocynth and antimonial powder each night, 
and repeated in the morning if necessary ; or a so- 
lution of sulphate of magnesia in plain water, or in- 
fusion of mint, with the addition of as much tartar- 
ized antimony as the stomach can bear, twice or 
thrice daily. 

When there is a disposition to inflammation and 
phymosis, and that a patient has a good appetite, 
which he is not inclined to disappoint, the exhibi- 
tion of this medicine is particularly advantageous. 
If the ulcers are at all irritable, confinement to the 
house will be almost as necessary as if the patient 
were undergoing a full mercurial course; and unless 
the ulcer is very inconsiderable indeed, the gentlest 
exercise will excite irritation. These ulcers will 
heal under the use of any simple astringent washes, 
or mild ointments; if, however, they should continue 
long obstinate in an indolent chronic state, mercury 
in alterative doses will indubitably hasten the cure: 
and an ulcer which, under different treatment, might 
not heal for several months, may thus be cured in a 
few weeks. This may be ascribed to the excitement 
of a new action in the part; and, with this view, I 
am in the habit of putting those affected with chro- 
nic indolent ulcers of the legs, arising from any 
cause whatever, on alterative doses of mercury, by 
which means the most obstinate of them are healed 
in a comparatively short period of time.^ 

* This remark the editor thinks he has often seen corroborated. 
Mercury should, however, be rarely given ^n such cases, in alter- 



94 PAPULAR VENEREAL DISEASE. 

With respect to local applications, I employ such 
as are most likel}' to heal the ulcers as rapidly as 
possible, from a belief in this maxim, that the 
sooner an ulcer which secretes a morbid poison ca- 
pable of infecting the constitution, is healed, the 
more likely is the constitution to escape contamina- 
tion. We have seen from the analogy of this to other 
morbid poisons, as well as from the decisive experi- 
ments of Mr. Evans, that the earlier the stage of the 
ulcer from which infection is taken, the more active 
or virulent is the poison; and that in proportion as 
the ulcer advances to the secretion of pus, in place 
of lymph, its contagious properties diminish. 

Influenced by these facts and considerations, 
when a patient applies to me with an ulcer in its 
6rst stage, while it is yet excavated and secreting 
lymph, I instantly endeavour to destroy its entire 
surface by a free application of lunar caustic ; and 
when the eschar separates, I have often the satisfac- 
tion of finding a simple sore instead of a poisonous 
ulcer. Not, however, confiding altogether to the 
first application, I direct the patient to keep lint 



ative doses, before the system is well prepared for it by the aati- 
phlogistic measures above recommended. The hydrargyri oxy- 
murias in such minute doses as will hardly be sensibly felt by the 
patient, namely, the one-eighth or one-tenth of a grain in pills or 
solution twice a day, frequently acts like a charm in healing ulcers 
of a very indolent character. Hence the reputation of certain 
Rob's, Panacea's and other nostrums, of which this preparation of 
mercury is the concealed basis, and which are most frequently 
resorted to in the declining stages, after the use of other mea- 
sures may have paved the way to their successful administration. 
This lucky application of them is the grand secret of those tniracu- 
lous cures which astound the public, and frequently perplex and 
even put to the blush our most able physician?. E. 



PAPULAR VENEREAL DISEASE. 95 

moistened in a solution of nitrate of silver, (in the 
proportion of three or four grains to an ounce of 
distilled water,) constantly to the ulcer; which so- 
lution I gradually diminish in strength as the sore 
assumes a healing disposition. 

An opinion has prevailed, owing, I believe, in a 
great measure to the writings of Mr. Benjamin Bell, 
that the application of caustic to primary sores ex- 
cites bubo. It may possibly do so by partially irri- 
tating, in place of wholly destroying the ulcer; but 
for my part, I have by no means found that bubo is 
apt to follow the application of caustic to the ulcers 
under consideration, when it is applied at the period 
that they are alone fitted for the experiment, viz. at 
their commencement, when they are in their exca- 
vated state, secreting lymph, and of small extent 
compared to that which they may afterwards at- 
tain. 

In the second stage of the sore, however, when 
its surface is either on a level with the surrounding 
skin, or raised above it, and that pus and not lymph 
is secreted, it would be folly to apply caustic with 
the object of cutting off infection, or altering its 
nature. It has already existed too long to afford a 
chance of the former, and the latter is unnecessary, 
as the ulcer is already approaching the nature of a 
common sore. The applications I employ in this stage 
are those most likely to accelerate the healing pro- 
cess, such as a solution of nitrate of silver in the pro- 
portion of one or two grains to an ounce of distilled 
water, or the blaxik or yellow mercurial washes; the 



96 PAPULAR VENEREAL DISEASE. 

lint with which any of these are applied ought to 
be changed thrice a day. 

When these ulcers become-very much raised, ex- 
hibiting a fungous appearance, touching them daily 
with sulphate of copper will hasten their cicatriza- 
tion. In some instances, particularly when the sores 
are on the external prepuce, or body of the penis, 
ointments are most suitable ; among these I have 
found the zinc ointment either alone, or blended 
with a third or a fourth of the nitrated mercurial 
ointment, the best application.* 

Whenever a disposition to phymosis occurs, the 
patient should be confined strictly to the recum- 
bent position, and desired to inject warm water fre- 
quently between the glans and prepuce. Poultices 
of bread and water may also be applied with advan- 
tage to the entire penis ; and the antimonial solution 
given in such doses as will excite slight nausea: but 
when the inflammation is violent, the penis consider- 
ably swollen, and attended with acute pain, if the 
most active measures are not immediately adopted, 
the inflamed parts will fall into a state of mortifica- 
tion. In these cases, the symptomatic fever runs so 
high, that the pulse is from 110 to 130, with thirst 
and restlessness. Cnder such circumstances, I im- 
mediately direct blood to be taken from the arm, in 
proportion to the urgency of the symptoms and 
strength of the patient, and repeat the venesection 

* The healing of these sores may likewise be greatlv expedited 
by the daily application on a piece of lint of a saturated solation 
of the sulphate of copper in water, with dressings of simple ce- 
rate or red precipitate ointment. E- 



PAPULAR VENEREAL DISEASE. 97 

every six or eight hours, until the inflammation be- 
gins to yield It is as necessary to have recourse 
to the lancet in those cases, as in pleurisy, or in the 
most acute ophthalmia. However beneficial local 
bloodletting may be in inflammation of other parts, 
it is scarcely admissible in this; for if the matter 
which flows from beneath the prepuce should come 
in contact with the wounds inflicted by leeches, 
troublesome sores might ensue, which would still 
farther add to the inflammation it was intended to 
subdue. By active measures of this kind, if employ- 
ed in time, we shall avert the usual result, viz. mor- 
tification of the prepuce, or suppuration of the body 
of the penis under its investing ligament. 

In some cases, a portion of the prepuce will 
slough in such a manner, as to leave an opening 
through which the glans penis passes out; and the 
remainder of the prepuce lying behind, or at the 
frenal side of the glans, forms a useless appendage 
when the parts are healed. When the other attend- 
ant upon inflammation of the penis, viz. the for- 
mation of matter under its ligament, takes place, the 
pain is excessive, from the unyielding nature of the 
ligament; and the entire penis acquires a state of 
constant tension, and becomes indurated in an ex- 
traordinary manner. The integuments are of that 
red colour which indicates the presence of matter 
underneath, but no fluctuation can be felt, on account 
of the thickness, and unyielding nature of the invest- 
ing ligament of the penis. This circumstance can 
only be discovered by the previous symptoms, the 
pain and tedious obstinacy of the disease, the cal- 



98 PAPULAR VENEREAL DISEASE. 

lous state of the penis, and the discolouration of its 
integuments. The matter at length, usually makes 
its way through that part of the dorsum penis near- 
est the pubis, where the ligament is found less 
dense than elsewhere ; and a probe will freely pass 
into the small round opening through which it flows, 
and may be moved, in any direction, under the li- 
gament. But instances sometimes occur, where the 
matter points over or above the pubis ; and, in this 
case, a deep abscess is always formed. In the pro- 
gress of the complaint, the ligamentous covering 
of the penis will occasionally ulcerate and slough 
away ; in which case, a foul and extensive ulcer, 
with averted edges, will occupy the dorsum penis, 
closely resembling, in appearance, that produced by 
a deep-seated paronychia, a day or two after a free 
incision has been made on the anterior part of the 
finger. Nor can we adopt a more certain mode of 
arresting the progress of the disease under consider- 
ation, than by a free incision of the dorsum penis, 
longitudinally through the ligament, before ulcera- 
tion takes place ; for if we wait for this event, the 
organization of the penis may be destroyed. But 
the matter, once allowed an exit, the pain, tension, 
and other symptoms, in general soon give way under 
the use of emollient applications. 

In some instances the matter finds a passage at 
the corona glandis, and the probe introduced into 
this opening will pass under the ligament of the 
penis,- often as far as the pubes, at the upper part of 
which sinus it will be necessary to make an open- 
ing; this will sometimes succeed, and the cavitv 



PAPULAR VENEREAL DISEASE. 99 

will gradually close. In other instances, however, 
amendment will not follow this step; the openings 
will contract, notwithstanding every attention, so as 
to prevent the discharge from flowing off, and the 
confinement of the matter will occasion much pain, 
and an appearance of pointing on the dorsum penis 
between the two openings. These tedious, painful, 
and embarrassing circumstances may be prevented 
by the timely use of a seton passed from one open- 
ing to the other, which occasions a free exit to the 
matter. As the discharge diminishes, the threads 
of the seton may be gradually reduced, until it is 
withdrawn altogether ; laying open the entire ex- 
tent of the abscess with the knife is too severe an 
operation, and would probably, in the swollen and 
diseased state of the parts, be followed by sloughing 
of the ligament, and disorganization of the penis ; 
enlarging the original openings in general only affords 
temporary relief. But in the mode of treating those 
cases by seton, I have, in many instances, perfectly 
succeeded in removing the disease, leaving the state 
of the parts uninjured. The preceding observations 
respecting the formation of matter under the liga- 
mentum penis, and the mode of treatment, of course, 
equally apply to the other forms of venereal dis- 
ease, as well as that which produces the papular 
eruption. 

The simple venereal primary ulcer, as well as 
every other description of primary ulcer, is liable 
to be followed by warts ; when they are numerous, 
and their bases comparatively broad, they will, in 
some instances, almost conceal the surface of the 



100 PAPULAR VENEREAL DISEASE. 

glans and prepuce, and it has long been a desirable 
object to possess an application capable of destroy- 
ing them. 

Practitioners agree that mercury does not affect 
them, and the common caustics, savin or verdigris, 
will, under the circumstances in question, require 
in the most favourable instances months for their 
removal; and, perhaps, fail after the most patient 
and continued perseverance in their use. 

But I have had the satisfaction of introducing an 
application which I have never knov/n to fail in any 
instance, however numerous and extensive these 
untractable excrescences. The idea of applying 
acetic acid to warts, was first suggested by a know- 
ledge of its extraordinary effect upon those well- 
known indurations of the cuticle called corns, which 
it will in general remove in one or two applications -, 
and, if not carefully managed, all the surrounding 
cuticle which it may happen to touch. But how- 
ever efficacious this remedy, I would only recom- 
mend its application to large warts with broad bases, 
on which it should be rubbed daily by means of 
lint on the end of a probe. Where they have nar- 
row necks, the most expeditious way, and one which 
is perfectly safe, is to cut them off with scissors, 
and afterwards, if it is thought necessary, apply lunar 
caustic to the wound, after the oozing of blood has 
ceased. 

Having considered the treatment of the simple 
primary ulcer, and its consequences, I shall proceed 
to make a few very brief observations on that of 
the patchy excoriation of the glans and prepuce, 
and also on gonorrhoea virulenta. 



PAPULAR VENEREAL DISEASE. 101 

Of all venereal complaints, the patchy excoriation, 
or chancrous excoriation, as it was formerly term- 
ed, is the most easily cured ; any mild astringent 
lotion, injected five or six times daily between the 
glans and prepuce, will remove it in a few days. 
That I usually employ is the yellow mercurial wash 
above mentioned; but weak solutions of acetate of 
lead or sulphate of zinc, or even simple ablutions, 
may answer equally well. It is so easily cured, 
even under common attentions to cleanliness, that I 
cannot conceive how some practitioners can have 
the conscience to subject their patients to a five or 
six weeks' course of mercury, for a complaint that 
simple water may remove in a few days.* This 
excoriation is, however, very generally accompa- 
nied with gonorrhoea ; and so commonly is this the 
case, that many have very judiciously given it the 
appellation of external gonorrhoea. 

We have now to say a few words on the treat- 
ment of gonorrhoea virulenta, the only remaining 
primary affection of the papular venereal disease to 
be considered. During the early or inflammatory 
stage of this affection, we observe that the discharge, 
though purulent, is thin, and stains the linen of the 
patient with a greenish hue; and that during this 
period, which corresponds with the first stage of 



* It might puzzle a moralist, or a phrenologist, to decide whe- 
ther in some medical heads the auri sacra fames ^ as to himself, or 
the hydrargyri sacra fames, as to his patient, forms the most pre- 
dominant propensity. But where both are combined, he would 
soon discover that their power is irresistible, and that poor co7i- 
scieniiousness would be allowed to remain in a state of perfect re- 
pose. 



102 PAPULAR VENEREAL DISEASE* 

the simple primary ulcer in its excavated state, 
when it secretes thin ichorous matter, the disease is 
in its most virulent and infectious state. But as this 
specific inflammation of the mucous membrane of 
the urethra subsides, the secretion from it becomes 
thicker, more purulent, and we may add, without 
much assumption, less infectious. 

During the first, or inflammatory stage, nothing 
farther can be done than to lessen the inflammation ; 
this sometimes runs so high as to excite sympathetic 
fever, and demands the use of the lancet; but it must 
be acknowledged that general blood-letting is sel- 
dom necessary, except rendered so by the impru- 
dence of the patient. In this stage I usually have 
recourse to my favourite solution of tartarized an- 
timony, with or without sulphate of magnesia. 

This medicine prevents the patient from indulg- 
ing a good appetite, lessens inflammation, and is the 
best preventive against painful erections or chor- 
dee. During its exhibition the patient is directed 
to dilute largely, which by causing frequent passage 
of the urina potus, washes off" frequentl}^, without 
irritation, the virulent matter secreted by the ure- 
thra.* 



* This useful intention may be promoted by frequent draughts 
of Gum Arabic water, infusion of Marsh Mallows, Linseed Tea, 
and Orgeat Sirop and water. One of the best drinks is prepared 
by dissolving 3J of Gum "rabic, and 9ij of purified Nitre, in a 
quart of Flaxseed tea. Of this the patient may drink plentifully 
during the existence of the ardor-urinae or other inflammatory 
symptoms. 

Painful erections and chordee are often very troublesome at- 
tendants on gonorrhoea. By the use of warm fomentations these 
are generally most quickly relieved, although the opposite plan 



PAPULAR VENEREAL DISEASE. 103 

I have been informed by several surgeons, that 
during the first stage of gonorrhoea, they have suc- 
ceeded in curing it almost instantaneously, by in- 
jecting into the urethra a strong solution of the ni- 
trate of silver ; for instance, ten or twelve grains to 

of bathing the parts in cold water, and applying it in a bottle or 
bladder between the thighs, occasionally better answer the pur- 
pose. A grain or two of opium with four or six of camphor, taken 
at bed-time, will often prevent the occurrence of these unpleasant 
symptoms during the night, but their permanent cure can only be 
expected from the employment of those general and local mea- 
sures best calculated to subdue the main disease, Chordee is 
supposed to be occasioned by an effusion of coagulable lymph into 
the cells of the corpus spongiosum, producing adhesion in its cells 
and preventing distention. When, therefore, an erection takes 
place, to which, owing to the excitement commonly present in 
gonorrhoea, the penis is exceedingly prone, the cavernous portion 
enlarges, but the undistended spongy portion acts upon it like 
a chord and bends it downwards. The hardness which sometimes 
remains after the inflammation and other symptoms subside, may 
be removed by the application of camphorated mercurial oint- 
ment. During the acute stages of gonorrhoea, bleeding from the 
urethra occasionally takes place, which, although it generally 
contributes to the relief of the patient, occasions him considerable 
alarm. Pressure made upon the canal with the hand, and con- 
tinued 15 or 20 minutes, will often be sufficient to arrest the 
haemorrhage. Sometimes, however, it is requisite to apply a 
roller over the whole penis, and pass a T bandage under the pe- 
rineum. The practice of introducing bougies for this purpose, is 
calculated to do mischief, by removing the clot and aggravating 
the inflammation. 

The sudden stoppage of the discharge in gonorrhoea, instead 
of affecting the testicles or other parts, sometimes produces a 
watery effusion into the prepuce, which becomes more or less 
distended like a bladder. The treatment which the editor has 
pursued in such cases, with unvaried success, consists, first, in the 
prompt removal of the exciting cause, whether this be exercise, 
an external irritant, or an internal stimulant, and afterwards the ob- 
servance of rest, with the use of cooling aperients and diuretics, 
arid more particularly frequent bathing the part affected in a watery 
solution of opium (3ss to ^viij) applied warm. Venesection is often 
highly necessary. The running generally recommences on the 
reduction of the excitement, and should not be suppressed by any 
means before the complete subsidence of the local and general in- 
jflammalion.. E 



104 PAPULAR VENEREAL DISEASE. 

an ounce of distilled water; that this injection 
caused at the moment great pain, but that no dis- 
charge afterwards followed its use, and the further 
progress of the disease was thus summarily stopped. 
Now although this information came to me 
through so many respectable channels, that I cannot 
doubt the fact, yet the practice is attended with 
such risk of exciting severe inflammation of the en- 
tire urethra and bladder and all the immediate as 
well as secondary train of e\'41s attendant upon this 
calamity, that I have no hesitation in saying that it 
is a practice that cannot be too strongly deprecated. 

However, we perceive that the success which has 
in numerous instances occurred, is analogous to that 
which follows the application of the same remedy 
to the simple primary venereal sore, during its first 
or excavated stage.* 

In the second stage of gonorrhoea the discharge 
is thicker and more purulent, and the disease be- 
coming milder, gradually loses, like the simple pri- 



* Warm fomentations applied to the penis during the inflammato- 
ry stage, will, in most cases, be found eminently serviceable. 
Simple water, or milk and water, made of a pleasant temperature, 
answers every purpose. The applications should be frequent, 
and continued for at least 10 or 15 minutes each time. 

The inflammatory attendants of gonorrhoea, viz: painful swel- 
Hngs of the glands and parts adjacent, and even of the testicles, are 
not always to be regarded as interdicting the use of the Balsam 
Copaiva, or other terebinthinate medicines. When the pulse and 
other signs indicate that the general action of the system does not 
correspond with the local excitement, these medicines may be 
often administered so as speedily to remove the disease with its 
local inflammatory symptoms. The result of this practice does 
not accord with the commonly received theories. In fact such a 
practice is only to be adopted at^ter the most careful consideration 
of the habil and narticular circumstances of the patient. E. 



PAPULAR VENEREAL DISEASE. 105 

mary ulcer, its specific or infectious properties. 
The purulent discharge at length ceases altogether, 
and the urethra returns to its former state, or to one 
of an increased mucous secretion, constituting the 
affection termed gleet, which may remain a very 
indefinite time. 

During the second stage, such medicines are 
found beneficial as seem to possess most power over 
the altered secretions of the mucous membrane in 
all parts of the body. No specific or anti-venereal 
powers are esteemed necessary in the remedies em- 
ployed even by those who consider gonorrhoea and 
chancre to arise from the same poison. Among 
these terebinthinate medicines have been long re- 
sorted to as affording the best means of curing go- 
norrhoea ; and balsam copaivse is the remedy upon 
which, with justice, most reliance is placed, when 
given in as large doses as the stomach can bear.* 

Cubebs, in some instances, has answered my ex- 

* The following formula will be found a highly advantageous 
mode of using this medicine: — 

R. Bals. Copaib. 

Spts. Nitri Dulc. aa ?j. 
Tinct. Opii 

Spirit. Camphorse, aa 5j. 
M. 
Of this, the ordinary dose may be a teaspoonful three times a 
day. 

The Balsam when thus administered, will, in general, be found 
less nauseous and oppressive to the stomach than when given in 
the more usual modes. To some stomachs, however, this medi- 
cine proves extremely oifensive in every shape, so that the 
whole system participates in its disagreeable effects. In such cases, 
it has been fonnd a good plan to omit the morning dose of the above 
mixture and substitute a moderate portion of some neutral aperient 
salt, after the operation of which, the Balsam may be taken libe- 
rally in the after part of the day. E. 



106 PAPULAR VENEREAL DISEASE. 

pectations; but, in the majority of cases, has disap- 
pointed them altogether.* 

If the discharge should continue obstinate, not- 
withstanding the above measures, recourse may be 

* Cubebs, to be used with advantage, require a nice discrimina- 
tion into the circumstances of the case, and even with every pre- 
caution on the part of the practitioner they will often disappoint 
his expectations. Being of a highly stimulating nature, their em- 
ployment is countermanded by the presence of much inflamma- 
tion, fever, or even a febrile or inflammatory diathesis, except 
these conditions be considerably on the decline. When the in- 
flammation is entirely confined to the mucous surfaces, they may 
be exhibited with more success than when it involves the neigh- 
bouring parts. From comparative observations made in the East 
Indies and elsewhere, there is reason to believe that they are 
best adapted to the gonorrhoea's occurring in the relaxed and less 
phlogistic constitutions of warm climates. To derive their full 
advantage, they should be administered in large doses, that is to 
say, from six to eight drachms of the powder per day, or as much 
as the stomach will bear. The following prescription unites the 
powers of the Balsam and Cubebs, and though deficient in elegance. 
has often made rapid cures. 

R. Pulv. Cubebae, 

Spts. Nitri Dulcis. _^ 

Bals. Copaibae, aa. 5ss. 

Pulv. Gum Arab. 

Sacch. Alb. aa 5ij' 

Tinct. Opii. gtt. xxx. vel. 5j. 

Aq. Fluvialis, 5vj. 

M. 
The dose may be a table spoonful every third or fourth hour. 
One of the best and safest injections adapted to gleet or the se- 
cond stage of gonorrhoea, is a solution of the Sulphate of Zinc, the 
strength of which should not at first exceed a grain or a grain and 
a half to the ounce of plain water or rose water, but may be 
gradually and safely increased to five or ten grains to the ounce, 
should the discharge continue obstinate. The remedies for Go- 
norrhoea ought not to be left off as soon as the discharge is arrest- 
ed, but continued for at least ten days longer, during which time 
they are to be gradually diminished. No case of gonorrhoea can 
be considered as cured until after the runninj^ and concomitant 
symptoms have disappeared for that length of time at least. It is 
to be regretted that the popular injection of Lead-water used in 
all stages of the disease, is so frequently followed by unpleasant 
consequences, of which gleet swelled testicle and stricture are 
the most common. E. 



PAPULAR VENEREAL DISEASE. 107 

had to astringent injections of a mild description, 
such as half a grain to a grain of the oxymuriate of 
mercury, in six or eight ounces of lime-water ; or 
from two to four grains of the sulphate of zinc, or 
sulphate of copper, in the same quantity of rose or 
distilled water, beginning always with the smaller 
proportion. 

When there is much irritability of the urethra, 
injections of any description are inadmissible; for it 
is far better to trust to time and internal remedies, 
than to tamper with stimulating applications, which 
may irritate the parts in their state of increased sen- 
sibility. Some are inimical to the use of any injec- 
tions whatsoever, and lay to their account the differ- 
ent unpleasant consequences which are so frequent- 
ly attendant upon gonorrhoea; such aschordee, in- 
flammation of the neck of the bladder, of the testes, 
and strictures of the urethra. 

There is no doubt, that the imprudent use of in- 
jections (which are most frequently irritating, though 
intended to be astringent,) may induce the com- 
plaints alluded to ; but at the same time, those com- 
plaints occur every day in patients who have not 
employed an injection. Strictures are more gene- 
rally attributed to the use of injections, than any 
other attendant of gonorrhoea ; but I have as fre- 
quently witnessed their occurrence where injections 
have never been used ; so that I am more inclined 
to ascribe these affections to the irritation of gonor- 
rhoea than to any other cause.* The sooner such ir- 

* During several years practice, in vvhicli the solution of Sul- 
phate of Zinc has constituted a favourite astringent injection, the 
editor has never had a single case followed by stricture or swell- 
ed testicle. E. 



108 PAPULAR VENEREAL DISEASE. 

ritation is removed, the more likely is the patient 
to avoid those unpleasant visitations, which are far 
more to be dreaded than the original disease. I 
have therefore no hesitation in putting as speedy a 
termination to the discharge as I can, by the use of 
the injections above recommended, if the internal 
remedies mentioned disappoint my expectations.* 

Should buboes attend any of the primary symp- 
toms detailed in this chapter, I have not learned from 
experience that mercurial frictions will discuss them; 
on the contrary, the trials I have made incline me 
to believe that this medicine tends rather to increase 
their inflammation, and, consequently, their tenden- 
cy to suppurate. But even under suppuration, they 
will heal much more readily than if the patient were 
subjected to a strong mercurial irritation. The ap- 
plication of leeches and cold lotions, with attention 
to rest and quietness, will often succeed in dispers- 
ing them. But buboes, in this form of venereal 
disease, are often remarkably hard and indolent, 
evincing neither a tendency to disperse or to sup- 
purate. In such cases, the greatest advantage may 
be derived from the repeated application of blisters 
to the indurated bubo ; which soon either cause the 
dispersion or the suppuration of the tumour, and 
thus free the patient from a troublesome symptom, 
which might otherwise continue many months to 
torment him. If suppuration takes place, it is my 
practice to allow tlie tumour to break spontaneous- 
ly, except the patient should suffer much pain be- 

* For further information relative, to strictures, swelled testicle^ 
<^c. see the supplement to this Chapter. E. 



PAPULAR VENEREAL DISEASE.. 109 

fore this event occurs, which often rentiers it neces- 
sary to use the lancet as a means of relief.* 

At the time of my former publication, when it 
was the general opinion that mercury was indispen- 
sably necessary for the cure of all venereal com- 
plaints, I deemed it incumbent on me to support 
my doctrines by adducing a host of cases that oc- 
curred in public hospitals under the eyes of numer- 
ous spectators : but now that it is almost universal- 
ly acknowledged that every form of venereal dis- 
ease can be cured without mercury, it is no longer 
necessary to overwhelm my reader w^ith the display 
of some thousands of cases, which might be brought 

* The treatment of buboes here recommended by the author, 
deserves particular attention, as it varies from the practice com- 
monly followed in this city, not less in form than in efficacy. The 
objections to rubbing in mercurial ointment are numerous and 
formidable. In the first pluce, the operation is dirty and disagree- 
able, rendering concealment almost impossible, and undoubtedly 
tending, as the author remarks, to encourage the disposition to 
suppuration. The only method, in which the editor has appUed 
the Ungt. Hydrarg. to buboes, apparently with good effect, has been 
as a dressing, to promote the discharge from blistered surfaces, 
and prevent their healing. Where mercurial frictions are em- 
ployed for the discussion of buboes, most, if not all, the benefit 
which may arise, should, perhaps, be ascribed to the action of fric- 
tion rather than to the virtues of the ointment. Indolent enlarge- 
ments of the inguinal glands may often be dispersed by applications 
of a stimulating kind, such .is the soap, volatile or camphorated lini- 
ments, which are far from being unpleasant. The editor would 
further observe, in relation to the application of leeches, that they 
are too often resorted to for the reduction of this and other spe- 
cies of inflammation, before they have a chance of doing good, for, 
Should the inflammation be high, and the pulse active, little bene- 
fit can be expected from their application. The smaller vessels 
may, indeed, be relieved for a short time, but the vigorous circula- 
tion in the larger vessels soon distends them again. To produce 
permanent effects the general increased action of the system must 
be previously reduced. E. 



110 PAPULAR VENEREAL DISEASE. 

forward to supjDort this doctrine. I shall therefore 
pass on to the consideration of the treatmbnt of 
THE CONSTITUTIONAL SYMPTOMS of the papular venereal 
disease. 

The papular eruption, and its accompanying 
symptoms, will yield, I firmly believe, in every in- 
stance to the powers of the constitution; but it 
sometimes requires several months to overcome the 
disorder, which will disappear and recur again and 
again in successive crops of the eruption, until at 
length, to use a familiar expression, it has entirely 
worn itself out. 

The cure, no doubt, will be considerably hasten- 
ed, when the disorder is on its decline, by the exhi- 
bition of alterative doses of mercury. These doses, 
as I can aver from very extensive experience, being 
quite sufficient for the purpose. 

The eruption is usually ushered in by consider- 
able fever, pains in the different joints, and frequent- 
ly with dyspnoea and pain in the chest : symptoms 
which often demand the repeated use of the lan- 
cet; and I have always observed that great relief is 
obtained by these depletions, and that the blood 
betrays the usual signs of the inflammator}' state. 
During this stage, the other means belonging to 
the antiphlogistic plan should not be neglected, but 
particularly the exhibition of antimonials. These 
afterwards, when the inflammatory diathesis is re- 
moved, I combine with decoction of sarsaparilla, and 
this treatment seldom fails to remove the symp- 
toms. But if the eruption and pains continue to 
linger. I usually direct j)ills of antimony and calo- 



PAPULAR VENEREAL DISEASE. 1 1 1 

mel, — for instance, the compound calomel pill, (Ph. 
Lond.) — in small alterative doses, together with the 
decoction of the woods, which, in the declining stage 
of the disorder, can be exhibited with safety, and 
has in no instance disappointed me in removing this 
form of disease, which is indeed the simplest and 
most manageable of these diversified complaints.* 

May we not presume, that the ease with which 
this disorder is cured, in some degree, arises from 
the fever or re-action of the system which attends 
it. In this respect it bears a close analogy to the 
exanthemata — poisons which the constitution over- 
comes by its own unassisted powers. And should 
we not, therefore, be careful, not unnecessarily to 
interfere with the powers of the constitution, which 
we have now sufficient evidence to assure us, are 
in every instance adequate to overcome the poison 
which induces this form of venereal disease ? 

If Hunter's account of the progressive, and never 
retrogressive symptoms of syphilis, when mercury 
is not employed, be true, may we not ascribe this 

* In such cases the oxymurias hydrargyri in such minute doses 
as will occasion no inconvenience to the stomach or system, will 
be found the most advantageous form in which mercury can be 
administered. Of nearly equal efficacy is the Plumber's pill or 
powder, 8 or 10 grains of which may be given as a dose, night 
and morning. The Plumber's powder is thus prepared. 
R. Sub. Mur. Hydrarg. 

Sulph. Aur. Antimon. aa 9j. 

Sacch. Alb. 5ij- 

M. 
The dose for an adult may be eight or ten grains, morning and 
evening. In this form the calomel undergoes such a chemical 
change, that its action is rendered much milder, and directed to 
the skin, and lymphatic system generally, rather than to the sali- 
vary glands or other organs. E. 



112 PAPULAR VCNEREAL DISEASE. 

circumstance to the want of that fever which attends 
the exanthemata, and the virus which produces the 
papular eruption. 

These observations were published in a former 
work, and it was only lately I discovered that the re- 
vered Linnaeus — that close observer of nature, who 
threw off the trammels of authority, and made use 
only of his own sound intellect and penetrating ob- 
servation, in ascertaining the properties and pheno- 
mena of organized beings, from the simplest vegeta- 
ble production to man himself — Linn^us, in his Ge- 
nera Morborum, places the venereal disease in the 
class of exanthemata, i. e. fevers attended with erup- 
tion on the skin. His English translator observes, 
" Our author stands alone in bringing syphilis (every 
form of venereal complaint is termed sjphilis) into 
the exanthematic ; and he considered himself justi- 
fied by its being attended, in the advanced state at 
least, by fever and eruptions.'** Linnaeus was per- 
fectly justified in doing so; for if the term exanthem 
is intended by nosologists to designate " a conta- 
gious disease beginning with fever and followed by 
an eruption on the skin," the various forms of vene- 
real disease, but in particular the one under consi- 
deration, have as strong a claim to be included in 
the class as either small pox or measles. 

I shall make so bold as to add, that venereal dis- 
eases ought to be treated on the same principle; 
and that, when we quit the plain dictates of gene- 
ral pathology, to follow those of mysticism, if not of 

* Pulteney's Linnaeus, by Maton, p, 144. 



PAPULAR VENEREAL DISEASE. 113 

empiricism, we only embroil ourselves in inextrica- 
ble errors, — rashly driving the eruption from the 
skin, heedless of the axiom of the philosopher Jen- 
ner, " that eruptions on the skin are the safeguards 
of the constitution;" and the consequence too fre- 
quently is, that the periosteum, bones, and deeper 
seated parts, become affected; and thus the disease, 
instead of yielding in a few weeks, requires months, 
nay, sometimes years, to restore the patient to his 
former state of health. This position is supported 
by the treatment found most beneficial for the other 
exanthemata. Who ever dreamed of such an ex- 
ploit as repelling the eruption of small pox or 
measles ? If this event should unfortunately occur, 
the most alarming symptoms ensue, in consequence 
of the lungs, or other internal organs, becoming 
affected. 

I have already mentioned, that the use of mercu- 
ry in the yaws, (a disease which deserves also to 
be placed among the exanthemata,) is abandoned, 
because it is found to drive the distemper from the 
skin to the periosteum and bones. Other diseases 
might also be adduced of the same character, in 
which this mal-treatment is equally dangerous. Cal- 
lisen, in the treatment he lays down for the northern 
leprosy, or radesyge of Norway, (and, as I have 
mentioned, probably the sivvens of Scotland,) states, 
that mercury, carried to the point of salivation, is 
always found to be injurious ; that repellant appli- 
cations should be decidedly shunned, as certain dan- 
ger is incurred by driving the acrimony of the dis- 

p 



1 14 PAPULAR VENEREAL DISEASE. 

temper upon the interior and more important 
parts.* 

The papular venereal disease is of such frequent 
occurrence, that I am within moderate bounds when 
I assert, that at least three-fourths of all the vene- 
real complaints which are prevalent in these coun- 
tries, are of that species, which gives birth to the 
papular eruption — a form of disease whicji I am bet- 
ter pleased to encounter than any other, as I am al- 
ways certain of seeing it yield without trouble to the 
mode of treatment I have detailed, unassisted by the 
disgusting and injurious process of a full mercurial 
course. Confinement, however, is necessary, and 
in cold weather should not on any account be dis- 
pensed with. The rapid amendment which takes 
place among hospital cases, in this species of vene- 
real disease, is a sufficient proof of the utility of 
confinement. 

I am, however, always better satisfied, in this 
form of disease, of the permanent safety of my pa- 
tient, where mercury has not been employed, than 
where it has ; for my experience enables me deci- 
dedly to affirm, that if the papular eruption, or its 
accompanj'ing symptoms, do not return in a patient 
tvho has not used mercury after a lapse of a few 
weeks, he may be considered as perfectly well ; but 
on the contrary, if he has employed that medicine, 
the disorder may return after an interval of many 

* Mercurium ad salivationem fortiorem usque porrectum semper 
nocuisse compertum est. Remedia externa reprimentia qua^que 
omnino ernnt evitanda, dum ab acrimonia ad interiores atque no- 
biliores partes delata certum periculum inducatur. — SystemaChi- 
rurg-. torn. i. p. 194. 



PAPULAR VENEREAL DISEASE. 115 

months, unless exhibited when the disease was 
manifestly on the decline ; and therefore I always 
consider a patient who has been treated without 
mercury, as much more secure against a relapse, 
than one who has employed it. 

Mr. Guthrie, in his observ^ations upon those cases 
which he treated without mercury, remarks that "it 
appears singular, that in the secondary cases, the 
symptoms should all have been of a mild nature ; 
in two instances only affecting the bones;" — and 
we should recollect that this was the small propor- 
tion which occurred in upwards of five hundred 
cases.* 

Mr. Rose also observes the same circumstance ; 
his words are, " it is now generally admitted, that 
the majority, and certainly by far the most serious 
diseases of the bones, as well as many other most 
distressing symptoms which are met with in all 
these diseases, are to be attributed to the injurious 
or excessive use of that remedy."t 

I shall take this opportunity of observing, that in 
the many hundred cases I have noted of the pa- 
pular eruption, which I have treated in the Lock 
and Richmond Hospitals, and in private practice, 
since my present views first occurred to me, I have 
not met with a single instance in which it was at- 
tended with nodes. But whether this was owing 
to the nature of the poison, or to the circumstance 
that mercury was not exhibited (except in a very 
small proportion of cases, when the disease w^as on 

* Med. Chirurg. Transactions, y. viii. p. 561. 
t Ibid. p. 425.- 



116 PAPLfLAR VENEREAL DISEAhli. 

the decline,) remains to be determined by future ex- 
perience. 

It is an undoubted fact that. ccBteris paribus, hos- 
pital patients recover more rapidly than private pa- 
tients, from their venereal complaints. This ap- 
pears to me to be evidently owing to the state of 
quietude in which the former remain in the warm 
air of their wards, not exposed to the cold, moist, 
and var3ing atmosphere of our climate, which our 
private patients, notwithstanding every exhortation 
to the contrary, have too often the fool-hardihood to 
encounter. The necessity of confining a patient 
to his apartment, when affected with an eruption 
which is usually attended with pains and consider- 
able constitutional derangement, few will be dispos- 
ed to denv, even althouorh mercurv should not be 
employed. The importance of this measure is, in 
my opinion, so great, that I have not a doubt but that 
a considerable share of the benefit which results, 
when a patient is put on a mercurial course, has 
arisen from his confinement to his room, which, ex- 
cept under the use of this medicine, is seldom thought 
necessary. 

A circumstance of an opposite nature, and which 
gives rise to an analogous mistake, is ine improve- 
ment that alwavs ensues, when scrofulous children 
are sent from crowded towns to the sea-side to bathe. 
The amendment is entirely attributed to the sea- 
water ; while the removal of the young patient from 
a vitiated to a pure atmosphere, together with an 
increase of exercise, and, consequently, of appetite 
and health, are in fact, the chief, though unnoticed 



PAPULAR VENEREAL DISEASE. Il7 

agents which effect the favourable chaii2;e that al- 
most always takes place in such cases. 

The general treatment of this disorder should be 
the same as that which has been found most service- 
able for the yaw^s, in w^hich mercury is injurious, 
unless emploj^ed at a late period, after the disease 
has nearly yielded to the powers of the constitution; 
because its exhibition, as I have elsewhere observ- 
ed, merely suspends the influence of the poison of 
this disease for a time, but does not supersede its 
action altogether, as is too certainly evinced by a re- 
turn of the symptoms, as soon as the mercurial ac- 
tion subsides, when it becomes more severe and te- 
dious than before. In fine, our object in the treat- 
ment of the constitutional disease under considera- 
tion should be, — 1st. To moderate the action of 
the system, if the fever which attends and accom- 
panies the eruption should be violent. — 2dly. After 
the fever is considerably lessened, or subdued, the 
exhibition of sarsaparilla, either alone or combined 
with antimonials, affords the most safe and effica- 
cious mode of treatment. The action of sarsaparil- 
la, particularly when assisted by antimonials, is to 
increase all the secretions ; and these must not be 
checked, particularly that of the skin, by imprudent 
exposure to cold. The diet of the patient may be 
light and nourishing, but not heating or stimulating, 
and he ought to increase the quantity of mild dilut- 
ing drinks he is in the habit of taking, which will 
assist the action of sarsaparilla on the skin and kid- 
neys. The practitioner himself should be observ- 
ant that this medicine is carefully prepared, and of 



118 PAPULAR VENEREAL DISEASE. 

a good quality. Not only boiling water extracts the 
virtues of sarsaparilla, but lime-water is supposed, 

by acting on the cortical part, to be equally effica- 
cious.* 

3dly. When the eruption has declined, no new 
spots appearing, and those that remain all desqua- 
mating or scaly, while the patient still complains of 
lingering pains in his head, elbows, hips, or knees, 
the disease being obviously on the wane, it may 
now be subdued altogether by alterative doses of 
mercury conjoined with antimony, for which object 
the compound calomel pill of the London Pharma- 
copoeia affords an excellent example: and with this 
medicine the sarsaparilla may still be continued. 
either in the form of decoction or infusion. "^ 

* The red sarsaparilla. «o named from the col r,r cf the inner 
bark, has been lately introduced into practice, and is t\iv superior to 
every other description. The decoction, according- to the London 
Pharmacopceia. is that I am in the habit of employing. The in- 
iusioD ot' sarsaparilla in lime-water may be made accordiag to 
the following formula. 

R. Sarsaparillas Rad. incisae, xiv. 
Glycyrrhiz3B Rad. contusae, ^i. 

Aquae Calcis. lb. iv. macera per horas xxiv. in vase lente 
c]aa«Ov dein cola. 

If we substitute the bark ot^ the root in place of the root itself, 
we shall have, of course, a more powerful infusion. 
A pint daily is the medium dose. 

' In doses of the eighth or tenth of a grain in the torm of pill 
or solution, repeated two or three times a day. the oxymurias hy- 
draro^yri operates very favourably in these cases. It is not the 
least recommendation which tbis preparation possesses, that it is 
capable of performing a cure without producing those unpleasant 
effects which often prevent that concealment which is in general 
so highlv desirable. The ?rand rule to be otsers ed in the ad- 
ministration of this, and all other preparations of mercury, in al- 
terathe dose^. is. never to be2"iii with them until fever, indamma- 



PAPULAR VENEREAL DISEASE. 1 19 

It may be useful to insert three or four cases, by 
way of example, of this form of venereal disease, 
and of the mode of treatment recommended. I 
shall, therefore, select out of the numerous cases 
already published, the following brief statements. 

Case 1. — Thomas Trainer admitted, December 
23d, 1812. His complaints were phymosis and pu- 
rulent discharge from the glans and prepuce, an ul- 
cerated bubo in the right groin, and an incipient 
bubo in the other. There was also considerable 
swelling and thickening of the scrotum, but the tes- 
ticles were of their natural size. He stated, that 
he was four months disordered, and that the first 
symptom with which he was affectedwas gonorrhoea, 
and that the other complaints shortly afterwards 
succeeded. I direct the antimonial solution,* and 
the lotion of calomel and lime-water. 

28th. — The discharge and swelling of the penis 
were entirely removed ; on retracting the prepuce 
the parts were free from ulceration. The ulcerat- 



tion and all other increased excitement or action of the system 
has been subdued. This rule not only applies to the treatment 
of the forms of syphilis, but should be kept in view whenever 
a mercurial is prescribed more as an alterative than as a prompt 
evacuant. E^ 

* The following is the formula of the antimonial solution em- 
ployed in the Richmond hospital. 

R. Antimonii Tartarizati, grana quatuor, 
Aquae distillatae septem uncias, 
Tinct. Cardamomi comp. drachm, tres, 
Tinct. Opii drachm. 
M. Syrupi Cort. Aurant. drachm, quatuor. sumatur cochi, 
ampl. ter quaterve quotidie. 



120 FAl^ULAR VENEREAL DISEASE. 

ed bubo was healing, and that of the other was de- 
clining fast. The swelling and thickening of the 
scrotum were also considerably lessened. He com- 
plained, however, of severe pains in his joints, par- 
ticularly at night. 

January 12th, 181'3. — The swelling of the scrotum 
had again increased, and he complained of soreness 
in his throat. On examination, the back of the pha- 
rynx appeared raw and excoriated, and the velum 
and uvula swelled and relaxed. I directed the dococ- 
tion of sarsaparilia, in conjunction with the antimo- 
nial solution. 

15th. — An eruption of papulse broke out all over 
his body, attended with high fever, pain in his chest, 
and difficulty of breathing. The scrotum and penis 
were very much swelled, and the prepuce so much 
swollen as to resemble a bladder of water. The 
soreness of his throat was increased, and tlie pains 
of his joints had become more severe. I directed 
that he should be blooded to sixteen ounces, and 
the antimonial solution to be continued without the 
sarsaparilia. On the following day his fever seem- 
ed to be considerably diminished, and his breathing 
was free. There appeared numerous small ulcers 
on the scrotum, which were probably the papulae, 
altered in their appearance by the friction to which 
they were exposed on this part during locomotion. 

21st. The swelling of the penis and scrotum had 
disappeared, and the eruption had entirely declin- 
ed, and on the 25th he was discharged the hospital 
well. The speedy termination of the constitutional 
symptoms in this case was probably, like those of 



PAPULAR VENEREAL DISEASE. 121 

the exanthemata, owing to the acuteness of the fe- 
ver, which was so high as to require the use of the 
lancet. The eruption closely resembled that repre- 
sented in Plate I. fig. 1. 

Case 2. — Michael Dunn, admitted December 31st, 

1812. His complaints were phymosis, with puru- 
lent discharge from the glans and prepuce, and a 
deep foul ulcer of the right groin. He stated that 
he was disordered two months before his admission, 
and that he had not used mercurv. I directed him 
to take the nitrous acid mixture dail}^, and to use 
the lotion of calomel and lime-water. 

January 6th, 1813. — An inflammatory red sw^ell- 
ing, the size of a dollar, appeared suddenly over 
the right tibia, to which I directed him to apply sa- 
turnine lotion, by means of folded linen. 

12th. — The discharge from the glans and pre- 
puce was stopped, and he could retract the latter. 
The tumour over the tibia w^as nearly dispersed, 
and the ulcer of his groin looked healthy, and was 
granulating. 

17th. — He was discharged the hospital well. 

Case 3. — Patrick Gordon admitted February 20th, 

1813. His complaints were phymosis, purulent 
discharge from the glans and prepuce, and an erup- 
tion of small red papul£e on every part of his bod}'. 
He complained of pains in his shoulders, arms, hips, 
and in the small of his back, Avhich were most se- 
vere at night. He stated, that he was five months 
disordered ; that six weeks before his admission he 
was attacked with pains in his joints, attended with 
feverishness, and that three weeks afterwards the 



122 PAPULAR VENEREAL DISEASE. 

eruption appeared. He had taken mercurial pills, 
which did not produce any beneficial effect upon his 
complaints. 

I directed him to take the nitrous acid mixture, 
and to inject the lotion of calomel and lime-water 
between the prepuce and glans.* 

22d. — The discharge was stopped, but the pains 
were more severe. On this day the drawing, as 
represented in fig. 2. Plate I. was taken of the erup- 
tion. 

March 1st. — The eruption had declined, and its 
vivid red colour was changed to a pale copper hue : 
the pains were more severe. I therefore discon- 
tinued the nitrous acid, and directed in its place, de- 
coction of sarsaparilla, and antimonial solution. 

4th. — The pains still continued to increase, with 
thirst, fever, and head-ach, pulse 110, difficulty of re- 
spiration, and severe cough. I directed that six- 
teen ounces of blood should immediately be taken 
from his arm, the decoction to be omitted, and the 
antimonial solution continued. The blood taken 
was highly buffed, and the following day he stated 
that he received the most decided relief by the de- 



* The author having omitted his formula for the preparation of 
this mixture, it may be well to mention the most convenient 
methods of administering the Acid. The simplest plan is to add 
ten or twelve drops of the Acid. Nitric. Dilut. to a small tumbler 
of water, which, when swallowed, will be so weak as not to injure 
the teeth. This dose ma}^ be repeated three or four times a day. 
But a more^agreeable method is to blend ^ij of the Acid. Nit. 
Dilut. with gviij of thick mucilage of gum arable, to which ^ss 
of lemon, ginger, or simple sirop, may be added. The dose of 
this is a table-spoonful, repeated three, four, or five times a dav. 

E. ^ 



PAPULAR VENEREAL DISEASE. 123 

pletion. His pulse was reduced to 90, and his thirst 
and fever were considerably lessened. 

15th. — He no longer complained of pains, the 
eruption had disappeared, and he was discharged 
the hospital apparently well. But he was re-admit- 
ted on the 26th of April following, on account of a 
fresh crop of the papular eruption, which had made 
its appearance since he quitted the hospital, attend- 
ed with pains in his joints as before. There were 
also swellings over the tibise, near the ankle joints, 
which were painful upon pressure ; and he called 
my attention to a small hard tumour, the size of a 
hazel nut, situated on the right testicle. I directed 
the antimonial solution, and venesection to twelve 
ounces. 

April 30th.— The pains and eruption continued 
as before ; the tumour on the testicle was, however, 
considerably reduced. Twenty grains of the com- 
pound powder of ipecacuanha were directed to be 
taken in the evening. 

May 1st. — The pains had become more severe, 
with oppressed breathing and cough; pulse 106. 
Venesection was directed to sixteen ounces, and 
the antimonial solution. The blood, as was the 
case in the former depletion, exhibited the usual in- 
flammatory characters, and was followed by consider- 
able mitigation of the severity of the pains, and re- 
lieved his chest altogether ; however, as I conceiv- 
ed that the most likely means to prevent a recur- 
rence of these symptoms, were to persevere in the 
plan from which he had derived so much relief, I 
directed that the venesection should be repeated on 
the 3d, from which he felt still farther relief. 



124 PAPULAR VENEREAL DISEASE. 

10th. — The eruption was declining rapidly ; he 
scarcely felt any pain ; and he was discharged the 
hospital, perfectly well, on the 20th instant. 

Case 4. — Henry Scully was admitted March 24th, 
1813. His complaints were a superficial ulcer on 
the prepuce, without induration, and papular erup- 
tion, which extended to every part of his body ; in 
some places the spots, when on the decline, ran into 
each other, so as to appear true syphilitic blotches to 
a superficial examiner. The papulae on his scrotum 
were larger than elsewhere, and were moist on their 
surface. He complained of pains in his shoulders, 
hips, and other joints. x\s there was not any febrile 
symptom in this case, I directed for him, on his ad- 
mission, the decoction of sarsaparilla, conjoined with 
the antimonial solution; he was also desired to keep 
lint, moistened in the lotion of muriate of mercury 
and lime-water, to the sores on the penis. 

29th. — The eruption was of a less vivid red colour, 
and his pains were considerably alleviated. 

April 5th. — The eruption had nearly disappeared: 
he scarcely felt any pain in his joints, and the sores 
on the penis had healed. 

13th. — His complaints being all removed, he was 
discharged. 

Case 5. — Cornelius Leary, admitted April 1st, 
1813, on account of small superficial sores on the 
corona glandis, excoriation and discharge of the 
glans and prepuce, gonorrhoea, and a bubo in the 
right groin. There was also an eruption of papulae 
on his breast and belly. He stated that he was dis- 
ordered six months, and that he underwent several 



PAPULAR VENEREAL DISEASE. 125 

courses of mercury, which had no effect whatsoever 
on his complaints. I directed him to use frequent- 
ly every day, an injection of a scruple of calomel, 
suspended by means of mucilage, in six ounces of 
lime-water, and to keep lint, moistened in the same, 
constantly applied to the surface of the glans and 
prepuce ; also the antimonial solution. 

7th. — The sores and excoriation of these parts 
were healed, the bubo was lessened, and the eruption 
was declining. 

13th. — The discharge from the urethra had ceas- 
ed, and the eruption had disappeared. He was dis- 
charged the hospital well. 

Case 6. — ^Michael Whelan was admitted April 
19th, 1813. His complaints were superficial ulcers 
on the corona and glans ; a large ulcerated bubo in 
the right groin, of a projecting fungous appearance, 
and a papular eruption on his breast, back, and face, 
nearly similar, but not of so deep a colour as those 
represented in Plate I. fig. 1. He complained also 
of pains in his shoulders, elbows, and ankles; the 
last were swelled, red, and painful on pressure. 
The lotion of muriate of mercury and lime-water, 
the antimonial solution, and the decoction of sarsa- 
parilla, were directed for him. 

May 3d. — The ulcers of the penis were healed, 
and the pains lessened. 

10th. — The eruption had declined, and the pains 
no longer remained. The ulcer of his groin was 
healing, and he was discharged the hospital well, 
on the 23d of the same month. 

Case 7. — James Corrigan, admitted September 



126 PAPULAR VENEREAL DISEASE. 

9th, 1813. His complaints were excoriation of the 
glans and prepuce, with purulent discharge ; a small 
superficial ulcer on the prepuce, without induration; 
a thick eruption of papulae on his face, arms, and 
neck ; a dry excoriated appearance of the posterior 
part of the pharynx; superficial ulceration and en- 
largement of the tonsils, accompanied with difficul- 
ty of swallowing ; and he complained of pains in his 
shoulders and elbows. 

He stated that he was six months disordered, and 
that he had been repeatedly salivated under differ- 
ent courses of mercury. 

I directed the same medicines as were employed 
in the preceding case, under which his complaints 
gradually amended, and he was discharged the hos- 
pital well, on the 18th October following. 

Case 8. — Michael O'Neil admitted into the Rich- 
mond Surgical Hospital, on the 25th November, 
1813; His symptoms were phymosis, and purulent 
discharge from the glans and prepuce, gonorrhoea, 
and ardor urinse, and a bubo in the right groin. His 
throat was inflamed, raw, and excoriated, and there 
was an eruption of papulae, of a paler colour than 
usual, scattered over the entire surface of his body. 
The drawing, Plate I. fig. 3, was taken on this day, 
and exhibits the eruption as it appeared on his 
belly. He complained of severe pains in his shoul- 
ders, elbows, knees, and legs. I directed the decoc- 
tion of sarsaparilla, antimonial solution, and the lo- 
tion of muriate of mercury and lime-water. 

28th. — The eruption had declined, but many fresh 



PAPULAR VENEREAL DISEASE. 127 

spots, nearly approaching the form of pustules, ap- 
peared on his face. He complained of severe pains 
in his heels, but those of his joints were much alle- 
viated. 

Dec. 13th. — The discharge from the glans and 
prepuce was stopped, the eruption and pains were 
almost dissipated, and he was discharged the hospi- 
tal on the 2d of January, 1814, apparently well. I 
saw him in about a fortnight afterwards ; he was 
complaining of a return of the pains, but they were 
not so severe as at first, and there were a few pa- 
pulse on his face and breast ; they were removed 
in a fortnight under the use of the antimonial solu- 
tion. 

I HAVE stated that inflammation of the iris is a 
very common affection in the papular disease. Mr. 
Travers, to whom modern surgery is so much in- 
debted, observes, that the occurrence of this disease 
during the use of mercury, is so well established 
and familiar a fact among persons who see much of 
ophthalmic diseases, that their first enquiry of a pa- 
tient, labouring under inflammation of the iris, is 
not whether he has recently contracted syphilis, 
but whether he has been taking mercury." And 
again he says, " It appears to me impossible to pro- 
nounce whether the iritis, so frequently presented 
after sores on the genitals, and accompanied by 
eruptions, is the effect of a morbid poison, or of the 
mercurial poison, or, thirdly, the casual effects of 
exposure to an exciting cause in a state of predis- 



128 PAPULAR VENEREAL DISEASE. 

position from the mercurial impregnation of the sys- 
tem."* 

One good effect of treating venereal complaints, 
without mercury, is, that we are enabled to remove 
that accumulation of doubts, which are eternally 
arising, while that medicine is employed, and which 
so often embarrass us to decide whether we ought 
to attribute the occurrence of new symptoms to the 
disease or the remedy. This remark is well illus- 
trated by the above quotation from Mr. Travers ; 
for the symptom under consideration, actually be- 
longs to a disease that will run its career, as I have 
seen in a multitude of cases, in opposition to the 
most extensive courses of mercury. It is, therefore, 
not unreasonable to suppose that Mr. Travers, in 
the majority of cases of iritis, may have met with 
that symptom in persons who had been extensively 
under the influence of mercury; and we cannot be 
surprised at his attributing iritis to the mineral and 
not to the morbid poison. But this candid writer 
will scarcely adhere to this opinion, w^hen he is as- 
sured that iritis is frequently found in those who 
have not used mercury ; and I believe it is equally 
certain, that it has never been observed in a patient 
who w^as salivated for any disease that was not ve- 
nereal. 

But inflammation of the iris, whether it originates 
from venereal infection, or from any other cause, 
will readily yield to mercury and the antiphlogistic 
means ; and the reason why mercury is so useful in 
those cases, is admirably well explained in Dr. 

* Surgical Essays by Cooper and Travers, p. 60. 



PAPULAR VENEREAL DISEASE. 129 

Farre's valuable letter to Mr. Travers, in which he 
observes, that he has uniformly regarded the mer- 
curial action as one of the most effectual means of ar- 
resting the disorganizing process of adhesive in- 
flammation, whether of the iris or of any other tex- 
ture of the body." Thus, by means of the mercu- 
rial action, the inflammation is arrested, and the de- 
position of coagulable lymph prevented. If,* how- 
ever, it has already taken place, instead of becom- 
ing organized, which would render the iris immove- 
able, it is absorbed through the influence of this me- 
dicine ; and the other stages of the adhesive inflam- 
mation are also prevented. 

Thus we find an explanation for the seeming 
anomaly, that the symptom of a disease should be 
cured by a medicine, which is incapable of arresting 
the progress of the disease itself; as must have been 
the case in those instances of iritis detailed by Mr. 
Travers, in which, it seems, the patients were un- 
der the influence of mercury, either before, or dur- 
ing the attack of this symptom. Mercury, however, 
though a powerful auxiliary in the cure of venereal 
iritis, is not absolutely necessary for its removal ; for 
we learn from the authority of Doctor Thompson, 
that seven cases, under his care, became well with- 
out its exhibition.* 

Dr. Thompson, in those cases, cured the disease 
by bleeding, blistering, and the antiphlogistic plan 
of treatment carried to the utmost extent ; and I 
understand from good authority, that he perseveres 

* Edin. Med. Journal, No. LIII. 
R 



130 PAPULAR VENEREAL DISEASE. 

in the same line of practice, with a success that 
authorizes him to continue it: and I believe, the 
profession at large will be more inclined to attend 
to the representations of this distinguished patholo- 
gist, than a recent author already alluded to, who 
announces with a ludicrous affectation of authority, 
that "the patient may be saved the inconvenience 
of blood-letting or blistering, as ttiey do not afford 
the smallest benefit, nor will they allay a single dis- 
tressing symptom." 

With respect to my own practice in this disease 
which threatens so rapidly to disorganize the eyes, 
and cause total blindness, I feel myself called upon 
to adopt every measure without delay calculated to 
check so dangerous an affection. While mercury 
is thrown in as speedily as possible, with a view of 
stopping the adhesive inflammation, I do not neglect 
to put in practice both local and general blood-let- 
ting, the application of blisters, the use of belladon- 
na, and the antiphlogistic regimen. 

In ninety-nine cases out of a hundred, these mea- 
sures will succeed if adopted in time, and I have 
met with one case only, which however, came un- 
der my care in the advanced stage of the disease, 
that resisted tiiis plan of treatment, and terminated 
in loss of vision. 

I shall not fatigue my reader by detailing cases, 
illustrating the success of the practice recommend- 
ed ; therefore, shall merely add the conclusions af- 
forded by the cases detailed in my work on the 
symptoms and specific distinctions of venereal dis- 
eases, published in 1818, since which period the 



P/VPULAR VENEREAL DISEASE. 131 

same treatment has been pursued, in several hun- 
dred cases, with the same happy result. 

"From those cases we learn many important facts; 
and, in the first place, that iritis is an attendant upon 
the papular eruption. 

By cases 1 and 5, it is ascertained that the papu- 
lar eruption will occur either after alterative or full 
courses of mercury. 

By cases 1, 8, 9, 10, and 1 1, that gonorrhoea alone 
is sufficient to produce the papular eruption. 

By cases 7, 8, 9, 10, 1 1, that iritis will occur where 
little mercury or none at all has been employed, and 
therefore that it cannot be attributed to that medi- 
cine. 

All the cases prove the utility of combining th€ 
depleting with the mercurial plan, for the cure of 
iritis. But the mercury was in every instance discon- 
tinued as soon as the mouth became affected. 

It is of moment to add, that I have met wnth 
a considerable number of instances of iritis, that 
viere not attended by any eruption whatsoever, 
which yielded to the same plan of treatment." 

I trust that I have, in the preceding observations 
on the first class of venereal diseases, adduced suf- 
ficient evidence to satisfy any reasonable mind, that 
the same virus may produce the three primary af- 
fections described in this chapter: that these prima- 
ry affections are all liable to be follovv ed by the same 
train of constitutional ailments, and that all the symp- 
toms of this disease, both primary and constitution- 
al, may be easily recognised and distinguished a^ 



132 PAPULAR VENEREAL DISEASE. 

to their external characters, by those who will en- 
deavour to discriminate one disease from another. 
When all venereal complaints were treated nearly 
alike, such discrimination may not have been thought 
necessarj^ for practical purposes ; but now that the 
baneful effects of this mal-practice is universally 
felt and acknowledged, the student, if he hopes for 
success, must learn to discriminate appearances, in 
order that he may judge of the true nature of the 
disease, and whether it is likely to be mild or malig- 
nant, brief or tedious, in its duration. And finally 
he may acquire a knowledge from those characters 
and appearances, which will enable him to deter- 
mine with promptitude and decision the mode of 
treatment best adapted for the case committed to 
his charge. 

It will scarcely be credited, that before I drew 
the public attention to these matters, all our profes- 
sional powers of discrimination exercised v»ith a 
view to ascertain the nature of a doubtful disease, 
were almost exclusively confined to two simple 
points, the history of the disease, and the effects of 
mercury upon it. ' As to the consideration of the 
external characters and symptoms of the disease, 
which, we should naturally suppose, would form the 
basis of our diagnosis, it was scarcely esteemed ne- 
cessary to throw away a thought upon the subject. 

Mr. Hunter, as I have already observed, was the 
first in later times w^ho suspected the existence and 
frequency of diseases resembling, but differing from, 
true syphilis. He does not, however, attempt to 
discriminate them by the appearance of their symp- 



PAPULAIi VE^EREAL DISEASE. J 33 

tomS, but by their history and progress under the 
use, or in the absence of mercury. For instance, 
if symptoms spontaneously disappeared before its^ 
adoption ; or if others arose while the patient was 
under its influence, he concluded that the disease 
was not syphilitic. His reasoning, however, on 
those doubtful cases, will be better understood by 
a perusal of the following case from his works : — 

"A gentleman had for some time blotches on his 
skin ; the face, arms, legs, and thighs were in many 
places covered with them; and they were in their 
different stages of violence. In this situation he 
applied to me ; and I must own they had a very sus- 
picious appearance. I asked him what he suppos- 
ed these blotches were ; he said he supposed them 
to be venereal. I asked him when he had a recent 
venereal complaint; he told me not for above twelve 
months. I then asked him how long he had had the 
blotches ; and the answer was, above six months. 
As this was a sufficient time for makins; observations 
upon them, that might ascertain better than the 
mere appearance what they were^ I asked him if 
any of the blotches that came first had disappeared 
in that time ? and he said many. I desired to see 
where those had been; and on examination I found 
only a discoloured skin, common to the healing of 
superficial sores. I then declared to him that they 
were 7iot venereal, for if they had arisen from that 
source, noiie of them would have disappeared. He 
now informed me, that he had been taking mercury ; 
and this information obliged me to hav^e recourse 
to further enquiries; and I therefore asked him. 



134 papUlaJi Venereal disease. 

whether while he was taking mercitry, many of the 
first got well ? The answer was, Yes. And was the 
cure of those imputed to mercury? The answer was 
again in the affirmative. I then asked him, if while 
he was taking the mercury^ which appeared to have 
cured some, those that now remained^ arose ? Yes^ 
My next question was, how long had he taken 
mercury ? He said for six months. I then declared 
they were not^ nor never had been, venereal. I ask- 
ed him, what was now the opinion of his surgeon } 
He said, that his opinion still was, that they were 
venereal, and that he should go on with the mercu- 
ry. I advised him to take no medicines whatever ; 
to Mye well, avoiding excess, and to come to me in 
three weeks, which he did, and then he was per- 
fectly well, only the skin was stained where the 
blotches had been. He now asked me, what he 
was next to do } I told him he might go to the sea 
and bathe for a month. This he did, and returned 
well and healthy, and has continued so."* 

If Mr. Hunter had lived some time longer, he 
would most probably have persevered in, and en- 
lightened this obscure and intricate subject; but 
this case entitles him to the merit of pointing out 
to his successors, the necessity of discriminating 
between syphilis and the resembling disorders. 
His Commentator, Dr. Adams, has added many 
useful observations ; and Mr. Abernethy has prose- 
cuted the inquiry with great advantage. He is of 
opinion, that the pseudo-syphilitic diseases cannot 

* Hunter on the Venereal Disease, p. 436. 



PAPULAR VENEREAL DISEASE. 135 

be distinguished from true syphilis by their appear- 
ances, but that we must trust to their history alone, 
A very simple fact, he says, has enabled him in 
most cases to distinguish between the two diseases^ 
which is, " that the constitutional symptoms of sy. 
philis are generally progressive, and never disap- 
pear unless medicine be employed ; and it may be 
added," he continues, " that they are as generally 
relieved under an adequate effect of mercury on 
the constitution."* The criterion by which Mr. 
Abernethy decides on the nature of those diseases, 
is that which guided Mr. Hunter's judgment in the 
case which I have just extracted from his works ; 
but however excellent this criterion, which should 
never be neglected, I do not hesitate to say, that in 
the great majority of eases, these disorders may 
not only be distinguished with ease from true sy- 
philis, but from each other, by the eye alone, and 
that whether the symptoms be local or constitu- 
tional. 

In the papular venereal disease, the eruptive fever 
is more strongly marked than that of syphilis ; and, 
in many cases, is so acute as to require repeated 
blood-kttings. The eruption is not scaly, like that 
of syphilis, but papular, disappearing and recurring 
repeatedly. The affection of the throat is not a 
deep ulceration of the tonsils, but an inflammation 
and superficial excoriation, or rawness of the fauces, 
but particularly of the posterior part of the pharynx. 
The pains do not affect the centre of the long bones. 

* Abernethy on diseases resembling Syphilis, p. 46, 



136 KiPULAR VENEREAL DISEASE. 

but the large joints. This disease is not attended 
by nodes, but iaiiammatoij swellings of the integu- 
ments have been mistaken for them, which occur 
suddenly, and as suddenly disappear, without the 
assistance of mercury. But although the actual 
appearances of the symptoms thus point out the 
nature of the disease, yet I would not l3y any means 
neglect such assistance as an inquiry into the his- 
tory of the case may afford. On the contrary, when 
instances occur of doubtful character, we should 
endeavour to ascertain whether the primary ulcers 
have healed spontaneously, or by the aid of medi- 
cine; or, while they healed in one place, if they 
broke out in another. If the eruption disappeared 
without the use of mercury, and afterwards recur- 
red. If it has happened, that mercury has been 
exhibited, its effects will also assist our diagnosis ; 
nothino; can be more certain or more decided than 
the improvement that follows the use of this mine- 
ral in all cases, either local or constitutional, which 
are truly syphilitic. Its effects in the other vene- 
real diseases are by no means similar. Sometimes 
it flatters with an early amendment ; sometimes the 
mischief is immediate, and an increase of ulceration 
the consequence ; but whether, in spite of the mer- 
cury, its progress continues, or, suspended for a 
lime, again resumes its ravages, the disease we may 
be certain is not syphilis, but one of those disorders 
so constantly and unphilosophically confounded 
with it. 

In the middle of a full course of mercury, the 
practitioner is often perplexed by the appearance 



i»APULAR rENEREAL DISEASE. 137 

€f a constitutional ulcer, or eruptioia, and he re- 
doubles his efforts to conquer the disease, by the 
exhibition of more mercury. But if that mineral is 
capable of superseding the syphilitic poison, it is 
absurd and contradictory to suppose, that while it 
is operating with sufficient energy to cure the symp- 
toms for which it was directed, it is possible for the 
poison to contaminate new parts; but there is little 
absurdity in acknowledging, that a poison of another 
nature, over which mercury does not possess any 
certain influence, may contaminate new parts while 
the constitution is under the fullest operation of that 
medicine. 

As the powers of the constitution are, in many 
instances, found competent to the cure of these dis- 
eases, we should make use of every means capa- 
ble of increasing and strengthening these powers. 
Therefore when the attending fever is subdued, 
generous diet and country air should be particular- 
ly recommended, if the chronic nature of the symp- 
toms, and the means of the patient will admit of 
their adoption. It frequently happens, that the se- 
condary symptoms of a disorder which was consi- 
dered to be syphilis, whether eruption, ulcers of 
the throat, or nodes, have disappeared unexpected- 
ly, during an accidental journey or excursion ; and 
most practitioners have been acquainted with, and 
surprised at the circumstance; but there can be 
little doubt, that in every such instance, the disease 
has not been syphilitic. 

I trust that the facts I have detailed will be the 
means of removing some of the most glaring obsta- 



1 38 PAPULAR VENEREAL DISEASE. 

cles which opposed a true knowledge of venereal 
diseases. The variety of symptoms, both local and 
constitutional, hitherto attributed to the syphilitic 
poison, not only baffled all attempt at description, 
but seemed to set at defiance every rational arransje- 
ment, and rendered the disease an exception to all 
other morbid poisons : a class of disorders which are 
remarkable for the uniformity of their symptoms, 
and obedience to laws known and determined. But 
syphilis, according to the received opinion, unlike 
to other poisons, assumed every possible shape and 
appearance, both in its local and constitutional 
symptoms. To awaken the readers attention to 
this point, L shall transcribe the following passage 
from Dr. Bateman's most accurate and useful work 
on Cutaneous Diseases: — -In the course of this 
Synopsis I have made only cursory allusions to a 
very important class of cutaneous eruptions, which 
are often the source of considerable embarrassment 
to the practitioner: I mean those which are the re- 
sult of the venereal poison. The subject indeed is 
difficidU and ?iot as yet sufficiently investigated; for 
these eruptions assume such a variety of forms, that 
they bid defiance to arrangement according to their 
external character; and. in fact, they possess no 
common or exclusive marks, by which their nature 
and origin are indicated. There is perhaps no or- 
der of cutaneous appearances, and scarcely any ge- 
nus or species of the chronic eruptions already de- 
scribed, ichich these secondary symptoms of syphilis 
do not occasionally resemble. Dr. Willan pointed 
out. among the papular, scaly, and exajithematous 



PAPULAR VENEREAL DISEASE. 139 

iiffedions, several species to ivhich the resemblance 
was most obvious; and the pustular and tubercular 
eruptions would furnish still more accurate examples 
of similarity. Nevertheless, there is, in many cases, 
a difference, which a practised e3^e will recognise, 
between the ordinary diseases of the skin, and the 
syphilitic eruptions, to which the same generic ap- 
pellation might be given; this is often observable 
in the shade of colour, in the situation occupied by 
the eruption, in the mode of its distribution, and in 
the general complexion of the patient. Hence, to 
a person conversant with those ordinary diseases, a 
degree of anomaly in these respects will immediate- 
ly excite a suspicion, which will lead him to inves- 
tigate the history of the progress of such an erup- 
tion, and of its concomitant symptoms. And it will 
frequently happen, that the most experienced ob- 
server can only arrive at a satisfactory conclusion, 
by comparing the cutaneous appearances with these 
concurring symptoms, and with the previous history 
of the disease."* 

This uncertainty, of which Dr. Bateman so for- 
cibly and, in the recent state of our knowledge, so 
justly complained, I believe n,ever existed; and I 
trust I have offered strong grounds to infer, that the 
appearance of the venereal eruptions is far from ir- 
regular, but that the embarrassment of the practi- 
tioner has arisen, not from any want of uniformity 
in the effects of those poisons, but in the circum- 
stance of his ascribing to one the diseases which 
arise from several poisons, 

* Bateman on Cutaneous Diseases, p, 329 



J4(> PAfl/LAR VENEREA t DISEASE^ 

The papular, pustular, and phagedenic venereal 
diseases, have hitherto beeft attended with more 
danger than the scaly or true syphilis; not because 
they are^ from their nature, in reality more formi- 
dable, but because they have not been distingmsh- 
ed from that disease, and have been subjected to an 
inappropriate remedy. Thus it happens, that the 
symptoms of those disorders recurring after the use 
of mercur} , that medicine is again resorted to, and 
the mercurial irritation is alternated so often with 
that of the disease, that the patient at length falls 
a victim to their combined effects, and in this way 
numbers are annually destroyed. When once 
known and discriminated from syphilisy they are no 
longer formidable. The powers of the constitutionj^ 
assisted by simple remedies, are sufficient for their 
cure ; they may be tedious, but they will not be de- 
structive. 



As the treatment of strictures^ swelled testicle^ and sonje other 
affections omitted by the author, constitutes a very important part 
of venereal practice, the editor will attempt to supply the defi- 
ciency with as much brevity as the subjects admit. 

Strictures. The symptoms indicating the existence of these 
obstructions in the urethra are — frequent inclination to urinate, 
generally first noticed by the patient, from the circumstance of 
his being often obliged to rise at night ; the stream forked or 
twisted, occasioneilly without, but more frequently with, an evident 
diminution of its size ; sometimes he is troubled with incontinence 
of uniic, but mostly discharges it in drops and sudden gushes. 
Nocturnal emissions constitute a frequent symptom. The most 
common seat of stricture is about six or seven inches from the ori- 
fice, at the union of the membranous and spongy portions of the 
urethra. The existence of one, if it is not soon removed, often 
leads to the formation of others. When this occurs, there may 
generally be found two or three thus distributed : one about three 
or four inches from the end, another at about five inches, and the 



StPl'LEMENt TO CIIAPTER Ml. 141 

ihird at six or seven inches : sometimes they are even more nume- 
i'ous, A gleety discharge ustfally attends the disease, together 
with dull heavy pains in the loins. 

The exciting causes of strictures are various, and for the iriost 
pai't, such as occasion considerable local and general excitement. 
The proximate cause appears clearly to be inllaromation, which 
thickens and contracts the memhranotrs coats of the urethra, so 
that it sometimes appears as if a strmg had been tied round it j at 
other times the contraction would seem to have been made by a 
broader band. 

Although the treatment of strictures is for the most part a me- 
chanical process, still great care is necessary in their commence- 
ment to subdue all local and general excitement by bleedings 
saline cathartics, diuretic and cooling draughts and abstemiousness. 
The importance of these general measures may be inferred from 
the circumstance that strictures are always aggravated and often 
brought on by dissipation or high living, whilst they are almost as 
certainly benefitted by an opposite course. 

Plain bougies will generally be found entirety sufficient for the 
safe and complete removal of these obstructions. Those made of 
waxed linen, if well prepared, are perhaps to be preferred, al- 
though the metallic and hollow elastic bougies are very good. 
The largest which the stricture will admit, is to be first introdu- 
ced well oiled, and the size must be subsequently increased as 
fast as the dilatation will permit. The time of introducing and 
retaining the instrument should be short at first, and afterwards 
prolonged, as the urethra becomes reconciled to its presence. 
The bougie is to be steadily and firmly pressed against the stric- 
ture, which in due time Avill certainly give way. To provide 
against relapses, an instrument of the largest size the urethra will 
easily admit should be passed every week or two, for man}^ months 
after the obstructions are removed. The patient may be taught 
to do this for himself. These observations, though chiefly applicable 
to permanent strictures, will generally prove equally adequate for 
. the cure of the spasmodic varieties. 

Sometimes the inflammation of gonorrhoea extending backwards 
becomes violent, and affecting the accelerator and other muscles, 
gives rise to paroxysms of extreme pain, attended with a suppres- 
sion of urine. This affection is most commonly met with in irri- 
table habits, and has received the name of the inflammatory stric- 
ture. The remedies for it are, copious bleeding, the warm bath 
or long continued spunging with warm water, leeches to the pe- 
rineum, anodyne enemas, the internal use of opium and camphire, 
with or without the addition of extract of cicuta. When the 
bladder is distended, we should wait for the violent irritation and 
inflammation to subside before we cautiously attempt the intro- 
duction of the catheter. 



142 SUPPLEMENT TO CHAPTER HI. 

To prevent inflammation of the testicles, patients with gonor- 
rhoea should have them supported by means of bag or hunting 
trusses made of silk or cotton netting. This preventive measure 
is likewise useful in the treatment of the disease when it ensues. 
The most frequent exciting causes are, the irritation of gonorrhcEa, 
acrid or stimulant injections and bougies, strictures and external 
violence. The usual premonitory and attendant symptoms are, a 
feeling of irritation and uneasiness far up the urethra, as if caused 
by the presence of a drop of urine laying in that part ; shooting 
pains along the course of the spermatic chord, extending through 
the abdominal ring and passing down to the epididymis, which is 
the chief seat of the inflammation, although the body of the tes- 
ticle becomes much afi'ected, painful and swelled to a considerable 
size. 

Energetic antiphlogistic measures are generally called for ; such 
as bleeding, purging with calomel and the neutral salts. A hori- 
zontal posture should be strongly enjoined on the patient. The 
local treatment may consist of lotions, the best of which are either 
the Liquor. Ammon. Acetat. or warm vinegar and water, applied 
by means of soft linen cloths; — sometimes poultices are useful. 
Leeches will be found serviceable after the reduction of the ge- 
neral excitement. 

A chronic and indolent enlargement of the testicle sometimes 
proves very obstinate. This affection the editor has seen cured 
by a mild course of the oxymuriate of mercury, aided by the ex- 
ternal application to the gland of camphorated mercurial ointment, 
gently stimulating embrocations, and suspension in a bag truss. 
Little danger results to the procreative powers from the hardness 
which often remains in the epididymis after the subsidence of the 
general enlargement, especially if only one is thus affected. If, 
however, suppuration has ensued, the danger is much greater. 

Fistula in Ferinoeo^ is another attendant on gonorrhoea, or rather 
on stricture. Though comparatively of rare occurrence, it is a 
formidable affection, and therefore the more deserving attention. 
In consequence of the inflammation and ulceration of the coats of 
the membranous portion of the urethra, the urine finds its way into 
the cellular substance of the perineum, penis and scrotum, where 
it extravasates, excites inflammation, suppuration, and ultimately 
gives rise to a fistula. A hard, but not very painful tumour is 
perceived opposite the bulb of the urethra. Most pain is felt in 
it at the time of urinating. Sometimes the patient's life is placed 
in great danger from the extension of the inflammation, not only 
to the parts enumerated, but throughout the integuments of the 
anterior and lower parts of the abdomen. In this case it is re- 
commended by able surgeons not to rely upon attempts to discuss 
the inflammation, but to provide against the danger from suppu- 
ration, sloughing &c.. by an early opening into the part. The 



SUPPLEMENT TO CHAPTER III. 143 

mode of performing this operation is thus described by Astley 
Cooper. — " Pass a catheter as far as the stricture will allow, then 
make an incision an inch beyond it ; after which pass a staff into 
the urethra, and cut directly upon it through the stricture ; by 
this means, present relief is not only afforded, but it may effectu- 
ally relieve the stricture by introducing an elastic hollow bougie, 
and suffering it to remain two or three days. The scrotum should 
always be opened at different parts, by means of incisions, to admit 
of the urine being evacuated by means of them, but not so as to 
endanger the wounding of the tunica vaginalis : by this method, 
and by this only, will sloughing be prevented. The application 
of a vinegar poultice to the scrotum, will be found extremely 
beneficial. Whether the extravasation is anterior to the scrotum, 
in it, or in the perineum, the early opening is always to be adopt- 
ed." When, by the adoption of these measures the dangers of 
sloughing and suppuration are surmounted, the original stricture 
is next to be attended to, as without its removal the fistula can 
never be completely cured. For this purpose the practitioner 
just referred to prefers the caustic to the common bougie. An 
instrument of a size which the urethra will readily admit, armed 
with the lunar caustic, well secured and scraped to a point like a 
pencil or crayon, must be dipped in oil and passed down to the 
stricture as quickly as possible. In general, half a minute will be 
long enough to keep the caustic applied to the stricture, and that 
the slough should have ample time to separate, the operation 
need not be repeated oftener than every second or third day. 
But although strictures have undoubtedly been removed by a few 
applications of the armed bougie, instances can be adduced to 
show that retention of urine, and other distressing symptoms, have 
been occasioned by the severe irritation which it often produces. 
It has even happened that false passages have been made, giving 
rise to fistula in perinaeo when it did not previously exist, the ar- 
tery of the bulb destroyed, alarming hsemorrhage consequently 
produced, and spurious aneurism formed. For these reasons it must 
appear evident, that, for the destruction of all kinds of strictures, 
the plain unarmed bougies are to be preferred, as long as any 
prospect remains of their effecting the object. The treatment 
will perhaps in most cases be considerably prolonged by adopting 
this more safe and less severe plan, but as the other frequently 
fails, even in the best hands, and may be highly mischievous in 
those of the rash and unskilful, we think there are sufficient grounds 
to justify our preference. Even after the removal of the stricture, 
the fistula has been found to remain uncured. Under such circum- 
stances, it has been recommended to keep the patient in the hori- 
zontal posture, introduce a flexible metallic catheter into the 
bladder, and suffering it to remain there three or four days, replace 
it with a new one. This last precaution is found necessary in 



144 SUPPLEMENT TO CHAPTER III. 

coneeqyenee of the action of the urine upoa the metal, by which 
the instrument has been so corroded as to break — an accident 
which exposes the patient to an operation similar to that for Li- 
thotomy. Perhaps the hollow elastic catheters would answer the 
purpose equally well, and as they are also corroded by urine, the 
same precaution relative to changing them should be attended to. 

Another affection, which originates from gonorrhoea, especially 
when it has been improperly treated, is what has been termed an 
irritable state of the bladder. 

The most prominent symptoms are, a very frequent inchnation 
to void urine^ all attempts to restrain which desire produce ex- 
treme pain in the regio pubes ; considerable discharge of mucus 
along with the urine, which is sometimes tinged with blood ; dis- 
tressing tenesmus^ The symptoms frequently bear so striking a 
likeness to those of stone, as to make it difficult to tell which dis- 
ease they belong to. This affection oiay, however, be distinguished 
by the patient's heing mo^t exempt from pain and uneasiness when 
the bladder is empty, at which time he can even bear to jump 
and exercise with a degree of freedom which would be attended 
with violent effects if he laboured under stone. The same exer- 
cise taken when the bladder was full, would occasion great pain. 

Dissections have shown the mucous coat and even the whole 
structure of the bUidder inflamed violently, and so contracted as 
not to be capable of containing more than from two to six or eight 
ounces. The inflammation has sometimes produced adhesions to 
the anterior parietes of the abdomen, and caused the patient to be 
curved forward. 

The treatment may be divided into the palliative and curative 
measures. Among the first are anodyne enemas and the intro- 
duction of opium and cicuta into the rectum ; injecting into the 
■urethra a watery solution of opium — for which purpose ^j may be 
rubbed down with 5vj or §yiij of gum arable water, or flaxseed 
tea, and injected warm. When the urethra will bear its presence, 
a hollow bougie is to be passed down, and the injection forced 
through it into the bladder. But sometimes the irritation is so great, 
that the attempt to pass an instrument occasions excruciating and 
long continued pain, for which reason it will be better to close the 
orifice of the urethra, and rub it in such a manner as to direct the 
injection into the bladder. As remedies of a more curative nature, 
we may enumerate the following. Diluent and mucilaginous 
drinks, particularly in the first stage, such as gum arable and water, 
orgeat and water, flaxseed tea, infusion of marsh mallows, &,c. 
Soothing laxative enemas should be frequently resorted to. 
Leeches may be often usefully applied to the perineum. When 
ulceration has ensued, it has been recommended by Astley Cooper 
to introduce an elastic catheter into the bladder, which is to be 
jeft for the urine to pass through, <?o as to prevent distensjoo of 



SUPPLEMENT TO CHAPTER III. 145 

the bladder, and thus favour the healing process. The same emi- 
nent surgeon recommends, that the medical treatment should con- 
sist of the administration of the Bals. Copaib. or the Aqua Kali purl 
combined with opium. The prescription of Dr. Cheston is a very 
good one ; it consists of a powder, composed of pulv. gum. traga- 
canth. comp. and the carbonate of soda, to be taken several times 
a day; during the intervals between each powder, the following 
mixture is to be taken. 

R. Tinct. Benz. Comp. Jij. 
Vitel. Ovi q. s. 
Decoct. Hordei Ibss. 
Ft. Mistura. 
Occasionally during and after a gonorrhoea, some of the lacunae 
o£ the urethra, inflame, suppurate and discharge their matter sud- 
denly into that canal. These little abscesses may be felt on 
the under surface of the urethra, and are commonly about the 
size of peas. They are frequently situated under the frenum, 
when the matter is discharged both externally and internally, 
and often alternately so for several weeks if not prevented. A 
small sinus with a fistulous opening, will thus remain for months, 
and even years, with an external orifice scarcely perceptible, 
near the lower junction of the lips of the urethra. This aflfection 
scarcely ever occasions the patient much pain or inconvenience, 
and is to be regarded as less severe than troublesome. When 
the abscess can be reached by the point of the lancet, the matter 
should be let out as soon after suppuration as possible. The fis- 
tulous orifice is to be enlarged by the daily application of a finely 
pointed piece of lunar caustic ; after which, the sinus is to be in- 
jected, with a strong solution of the sulphate of copper. In this 
way, the cavity of the abscess may be obliterated, by the aid of 
adhesive inflammation. A similar treatment is applicable to the 
treatment of those sinuses with fistulous openings, which are left 
in the groins after the suppuration of buboes. If a little of the 
same solution can be forced into them, they will quickly heal. The 
same object may be attained by laying them open with a knife or 
bistoury. 

When, through the fault of the patient or his attendant, the 
cure of gonorrhoea has not been complete, and a gleet has suc- 
ceeded, a new plan of treatment often becomes necessary. Some- 
times in this affection, the discharge consists of an almost transpa- 
rent mucus ; whilst at others, it appears yellowish and opaque. 
The treatment consists of general and local measures. When a 
stricture is present, it must first be removed. Sometimes the in- 
jection of Vitriol Alb. gradually increased, and long persisted in, 
cures. Tinct. Cantharid. beginning with fifteen drops, three times 
a day, in a glass of water, and increasing a drop each dose, daily, until 
stranffurv, or considerable irritation at the neck of the bladder is 



146 SUPPLEMENT TO CHAPTER III. 

produced, will often remove it. The strangury raay alwa3?s be 
relieved by a free use of diuretic and diluent drinks, and leaving 
off the drops. Balsam and turpentines are often adequate to the 
cure of gleet. The editor has seen very obstinate cases soon 
yield to the exhibition of a teaspoonful of the Pulv. Cort. Peruv. 
with the addition of twenty or thirty drops of the Bals. Copaiva; 
taken three or four times a day. The formula is both homely and 
nauseous to the taste, but deserves recommendation for its having 
made cures when every thing else has failed. Bark and steel, 
either alone or conjoined, are often prescribed ; sea bathing and 
the cold bath are frequently useful. Blistering the perineum 
and lower surface of the urethra, has effected cures. Finally, 
the employment of bougies has often proved efl&cacious, and it is 
sometimes useful to dip them in a mixture of equal parts of Olive 
Oil and Balsam Copaivae. 

The different conformation of women, gives rise to a corre- 
sponding variation or modification in the diseases which are the 
subject of this treatise. This circumstance, we may readily sup- 
pose, would be ably met by the experienced practitioner ; but it 
is calculated to occasion some embarrassment to such as have 
only had limited opportunities. In the first place, it may be ob- 
served, that from the greater simplicity of the structure of those 
parts which are the seats of the disease, or some other reason, 
women are exempt from many of the symptoms to which men 
are liable, and in general, feel less inconvenience from those 
which they may have. Indeed, it is no very rare occurrence for 
a female to have a gonorrhoea without being able to discover it, 
except by the marks on her linen. The inflammation first appears 
in the nymphae, and afterwards extends to the labia. The dis- 
ease is usually felt with most severity in the meatus urinarius and 
urethra, from the shortness of which canal, it easily makes its 
way along the lining membrane into the bladder. When this 
happens, the suffering is considerable, and like the irritable state 
of the bladder in men, much distressing tenesmus and bearing down, 
both in the bladder and rectum, are occasioned. 

The treatment necessary, chiefly differs from that recommend- 
ed for the disease in the other sex, in being less energetic, 
except in regard to injections, which, after the subsidence of the 
inflammatory stage, may be used of much greater strength, A 
syringe of a peculiar formation has long been in use, but in gene- 
ral, a piece of soft linen or sponge, wet with the injection or 
lotion, introduced and confined in the vagina, answers every pur- 
pose as well or better. Frequently all that is requisite, is to wash 
the parts often with the lotion, by means of a piece of soft old 
linen. E. 



CHAPTER IV. 

PUSTULAR VENEREAL DISEASE. 

The primary ulcer of this disease is characterized 
by a reddish brown surface, which borders closely 
on the phagedenic character. Its edges are raised, 
and well defined. It is not excavated, but is either 
on a level with the surrounding skin, or consider- 
ably raised above it. At its commencement it ap- 
pears in the form of a small pustule, attended with 
itchiness of the part. 

It may be distinguished from the primary ulcer 
of the papular disease, by its well defined and ele- 
vated edges, and also by the absence of the smooth 
fungous appearance which characterizes the second 
stage of that ulcer. From the phagedenic primary 
ulcer to be described in the next chapter, it may be 
distinguished by its well-defined margin, and from 
the absence of the irregular and corroded-like sur- 
face of that ulcer, and also by its exemption from 
the painful and acute symptoms by which the pha- 
gedenic ulcer is characterized. It may also be dis- 
tinguished from chancre by its want of the callous 
edge and base which always attend that ulcer. The 
ulcers of which we are treating, are most frequent- 
ly found on the external surface of the prepuce, bo- 
dy of the penis, and occasionally on the scrotum, 
and occur from the size of the smallest pea, to that 
of a shilling. Of the former size they frequently 



148 PUSTULAR VENEREAL DISEASE. 

form a circle round the orifice of the prepuce, and 
occasion, when the ulcers heal, a permanent phy- 
mosis, which can only be removed by the knife. 
They are, in general, of a chronic nature, and evince 
but little disposition to spread. 

Mr. Evans conceives, that this primary ulcer, and 
that of the papular disease, are one and the same; 
and that I have been led into the error of supposing 
they were essentially different, by having observed 
the same ulcer in different stages of its progress, 
when it exhibits different characters. He sup- 
poses that this ulcer, which, I have said, has "the 
appearance of excavation," is nothing more than the 
primary ulcer of the papular disease in its ulcera- 
tive stage, which, in general, ceases about the eighth 
day, when the ulcer begins to assume its raised, 
smooth, fungous character. In confirmation, how- 
ever, of my own opinion, I have only to observe, 
that the primary ulcers I am considering will ex- 
hibit for w^eeks, nay, sometimes months, the same 
excavated appearance, arising from the same raised 
edges which they displayed in the first week after 
their attack; and that they do not, during their en- 
tire progress, exhibit the smooth fungous surface of 
the priaiary ulcer of the papular disease. 

Besides, in those cases in which I have been able 
to trace this ulcer to its constitutional symptoms, 
they were essentially different, as I shall presently 
show, from those which attend the simple primary 
ulcer, considered in the last chapter; and these cir- 
cumstances. I conceive, sufficiently warrant me in 
the assumption, that these ulcers are essentially dif- 



PUSTULAR VENEREAL DISEASE. 149 

ferent, and arise from different poisons. I must, 
however, admit that I have not met with many in- 
stances in which I was enabled to follow this ulcer 
to its constitutional symptoms. 

In the appendix to my former edition, I detailed 
two cases, in both of which the eruption was pus- 
tular, and afterwards spread into ulcers, covered, 
on their first formation, wdth thin crusts.^ 

In the London Medical Journal for 1815, 1 have 
given a considerable number of examples of this 
species of ulcer, three of which were attended by 
constitutional symptoms. The eruption in each 
was preceded by fever, and consisted of phlyzacious 
pustules, some of which declined, while others ul- 
cerated, and were covered with thin scaly crusts. 
These cases, being of great importance, as connect- 
ing the primary with the constitutional symptoms^ 
I shall transcribe before I conclude this chapter. 
They are all short, and one of them having relapsed 
since that publication, is entitled to a little farther 
attention. 

I have had occasion frequently to observe, that 
the buboes which arise from this virus, resemble 
the primary ulcers of the same specific infection, in 
their tendency to form projecting or undermined 
edges (particularly where much mercury had been 
employed,) and if these edges are not removed by 
art, remain for months, and perhaps years, without 
healing. Caustic, however powerful, is so slow in 
its operation upon the extensive and undermined 

* See Plate II. 



150 PUSTULAR VENEREAL DISEASE. 

edges of these buboes, that I always make use of 
the scalpel for their removal ; and this treatment 
has caused many of them to heal in five or six weeks, 
which would have resisted any other mode of prac- 
tice as many months. 

Full courses of mercury always increase their 
tendency to biirroiv, as it is technically called; and 
while I was a pupil, I had an opportunity of wit- 
nessing their ravages on many an unfortunate vic- 
tim : the integuments covering the lower part of the 
abdomen, even as high as the navel, were often un- 
dermined or destroyed; but the inveteracy of the 
ulcer was at that time altogether attributed to the 
disease, and the more it spread, the more abun- 
dantl}^ was the infallible specific exhibited. 

The primary ulcers with elevated edges, are often 
extremely obstinate under the use of mercury. I 
have frequently seen that medicine exhibited in full 
doses, which maintained a strong mercurial action 
in the system for several months without inducing 
them to heal. A knowledge of this circumstance 
may be useful to those who are not predetermined 
to shut their eyes to every kind of evidence, as it 
may induce them to doubt the propriety of putting 
their patients through a mercurial course for every 
species of primary ulcer, or of persevering an uncon- 
scionable time in the use of this medicine, after they 
find that it has not produced the slightest favour- 
able change in their patient. 

Stimulating and caustic applications certainly pro- 
duce no beneficial effect ; and, if the ulcer is irrita- 
ble, encourage it to extend. In fact, our principal 



PUSTULAR VENEREAL DISEASE. 151 

care sho\ild be to keep the patient at perfect rest; 
and this observance, with gentle astringent applica- 
tions, or mild ointments, seems to be all that is re- 
quisite. As, however, patients affected with vene- 
real complaints are dissatisfied unless some medi- 
cine is prescribed, it is necessary to indulge them. 
My prescriptions are, antimonials or sarsaparilla, or 
both combined. I shall postpone my observations 
on the treatment of the constitutional symptoms of 
this disease, till I come to treat of the constitutional 
symptoms of the phagedenic ulcer, as there is little 
or no difference in my mode of treating them. 

It is altogether superfluous to burthen this essay 
with cases of the primary ulcer with elevated edges, 
as I have already published so many instances of 
their treatment without the use of mercury. It is 
equally unnecessary to detail any cases of the con- 
stitutional symptoms, which resemble those that I 
had traced to the primary ulcer under consideration, 
several hundreds of which I have noted, and can 
readily prepare for the press, if it could possibly 
serve any useful purpose to give them to the public. 
I shall, however, detail a few of the cases in which 
I had an opportunity of tracing the primary to its 
secondary symptoms. 

C«5e 9.— Philip Lynch, admitted March 12, 1815: 
an ulcer with elevated edges situated on the ex- 
ternal surface of the prepuce, the size of a bean : 
a large ulcerated bubo, with raised edges, in the 
left groin. He stated that he had been six weeks 
disordered, and had not used mercury. Solut. An- 
tim.— Decoct. Sarsap. — Sol. Zinci pro Lot 



152 rUSTL'LAR VENEREAL DISEASE. 

27th. The ulcer of the penis was nearly healed ; 
the edges of the bubo were, however, more raised, 
and projecting. 

April 3d. Two spots covered with thin crusts, 
about the size of a sixpence, each raised upon a 
circular inflamed base, had appeared, the one on his 
thigh, and the other on his arm. He stated, that 
he had only observed them three days before, at 
which time they resembled large pimples. Decoct. 
Rament. Lign. Guaiac. — Gum Guaiac. gr. v. ter in 
die. The edges of the bubo were touched daily 
with caustic. 

17th. The ulcer of the prepuce nearly healed; 
the edges of the bubo, which projected and over- 
hung to a great extent, notwithstanding the daily 
application of caustic, were removed by the knife. 

24th. A rapid amendment of the bubo had ensued 
since the removal of its projecting and over-hang- 
ing edges ; the ulcer of the penis and the constitu- 
tional ulcers had healed. 

May 22nd. The bubo, which continued so long ob- 
stinate, had also, at length, cicatrized. 

Discharged the hospital well. 

Case 10.— Henry O'Neil admitted June 7, 1815: 
the body of the penis was encircled by a series of 
ulcers with elevated edges, each about the size of 
a silver penny; there was also one on the external 
surface of the prepuce, and a large pustule, which 
I recognised as the commencement of one of these 
ulcers, on the glans penis; an incipient bubo in the 
right groin; a phlyzacious spot on his right side, 
v/hich accurately agreed with the constitutional 



PUSTULAR VENEREAL DISEASE. 153 

eruption described in the preceding case. He stated 
that he was five weeks disordered, that he had not 
used mercury, and that a fortnight before his admis- 
sion the spot on his side had appeared. Solut. An- 
tim. — Sol. Sulp. Zinci pro Lot. 

13th. — The ulcers of the penis were healing ; the 
phlyzacious pustule had formed a thin crust about 
the size of a sixpence. The bubo, which was hard 
and indolent,! directed, to be treated by successive 
blisters. 

26th. — The ulcers of the penis were healed; the 
crust had fallen from the spot on his side, leaving 
the part healed ; the bubo was almost entirely dis- 
persed under the application of the blisters. 

Discharged the hospital well. 

Case H. — John Quinn, admitted June 20, 1815; 
an extensive ulcer with elevated edges engaging 
the greater part of the dorsum penis, and extending 
up the pubes ; it was covered with thick adhesive 
matter, and attended with inflammation and swell- 
ing of the entire penis ; pulse 100 ; thirst, severe 
pain, and general symptomatic fever. He stated 
that he was a month disordered, and had not used 
mercury. Vensesect ad xvi. — Solut. Antim, — Fotus. 
— Catapl. 

July 3d. — The swelling and inflammation were 
reduced, and the ulcer, which was considerably im- 
proved, exhibited more decidedly the characteristic 
elevated edges. 

11th. — An eruption of pustules corresponding 
with the former description of phlyzacia appeared 



154 PUSTULAR VENEREAL DISEASE. 

on his face and breast; he complained of pain in his 
head and right arm. 

17th. — The eruption continued to extend over 
his body, each spot quickly forming a crust after its 
appearance. The fauces were inflamed, and a su- 
perficial ulcer had appeared on the left tonsil ; the 
ulcer on the penis was healing. Decoct. Sarsap. — 
Vin. Antimonii gutt. xx. ter in die. 

August 2nd. — The ulcer of the penis continued to 
heal, that of his throat had cicatrized; he still com- 
plained of pains in his head and arms ; the spots 
had all formed crusts, some of which had enlarged 
to the extent of a shilling. On his back and shoul- 
ders were eight phlyzacia, one at its commencement 
and in its progress to the formation of matter, three 
arrived at maturity, and terminated in apices contain- 
ing matter, and four in the declining or scabbing 
stage. 

7th. — The ulcer of the penis had healed, no fresh 
spots of the eruption had appeared. 

21st. — The crusts had fallen from the greater 
number of spots, leaving the parts healed; he com- 
plained of pains in his head and thighs. 

Sept 1st. — Several fresh phlyzacia had appeared 
on his arras and thighs, which quickly formed crusts, 
covering ulcers : two of these crusts had extended 
to the size of half-a-crown ; they were flat and of 
a straw colour. He was desired to discontinue the 
decoction and antiraonial wine, and take thrice a 
day a pill containing three grains of antimonial 
powder and half a grain of calomel.* 

* The reader will perceive that I have improved in my mode 
of practice siace these cases were origiaally published. The ex- 



PUSTULAR VENEREAL DISEASE. 155 

1 1th. — The ulcers were rapidly healing, and the 
smaller phlyzacious pustules, after forming thin 
crusts on their apices, were gradually declining. 

18th. — The eruption had entirely disappeared, 
but each spot left the skin slightly discoloured. He 
M^as detained in the hospital, however, until the 30th 
of September. The calomel contained in the pills 
had not affected his mouth. The eruption in this 
case was more general, and the spots more numer- 
ous than I had witnessed in any other instance of 
this form of venereal disorder. 

He was re-admitted into hospital on the 30th of 
November following, at which time there were 
three healthy granulating sores on the left arm, 
varying from the size of a shilling to that of half-a- 
crown. There was also an ulcer in each of his hams. 
Mist. Acidi. Nitrosi, 

December 26th. — All the ulcers had healed like 
common sores, the cicatrix commencing at their 
margins. Soon after the ulcers had healed he be- 
came feverish and unwell, complained of loss of appe- 
tite and rest, and began to feel pains in his shoulders, 
hips, and knees. Decoct. Sarsap. — Solut. Antim. 

January 8th, 1816. — Pains still severe. Pil. Ant. 
& Cal. ter die. 

February 5th. — Pains of his joints lessened, but 
he complained of severe pain in his chest, which 
was relieved by a blister. 

16th. — Several phlyzacious pustules and small 
spots the size of peas (immediately forming scabs) 

hibition of mercury at this period of the eruption was prema- 
ture, and to it may be attributed the subsequent relapse and ap- 
pearance of nodes. 



life PUSTULAR VENEREAL DISEASE, 

had appeared on different parts of his body. He 
also complained of pains in his knees. 
R. — Gum Guaiaci i. 

Pulv. Antira. 5 ss. ft. Pil. xx. 

Capt. Unam. ter die. 

Decoct. Lig. Guaiaci. lb. i. quotidie. 

22nd. — A node had occurred on the right tibia, 
attended with pain and tenderness upon pressure. 
This was blistered for about a fortnight, and it af- 
terwards gradually disappeared. The pills were 
discontinued for the solution of muriate of mercury, 
and decoction of sarsaparilla, which he continued 
until the 14th of March, and was discharged the hos- 
pital well. 

Case 12. — Mr. D. put himself under my care on 
the 19th of April, 1816, on account of an ulcer on 
the glans penis about the size of a sixpence, of a 
phagedenic surface, but with high edges; there 
were also several spots on his arms and thighs cov- 
ered with thin crusts. 

With considerable alarm, he communicated his 
apprehensions that he never could recover, because 
the smallest quantity of mercury so affected him as 
to excite an eruption with high fever ; from an at- 
tack of which he had just recovered; he, at the 
same time, showed me his hands, which were raw 
and tender, the entire cuticle with the nails having 
peeled off, an inconvenience very generally attend- 
ant upon the eczema mercuriale, when that com- 
plaint is severe. His feet, he mentioned, were in 
the same state. — I assured him that he need not be 
dispirited, as his complaints did not require mer- 



PUSTULAR VENEREAL DISEASE* 157 

cury for their cure. I directed for him decoction of 
sarsaparilla, and the antimonial solution, and also ^ 
lotion of muriate of mercury and lime-water to ap- 
ply to the ulcer. 

On the 23d, I was surprised to find my patient 
affected with the eczema mercuriale, which had 
commenced on the inside of his thighs and groins. 
He assured me that he had not used any medicines 
but those I had ordered; I could only, therefore, 
attribute the attack (for there could not be a doubt 
as to its nature) to the mercurial wash he had em- 
ployed. In this opinion I was strengthened by a 
curious fact he mentioned, that at a time when he 
was totally free from any venereal complaint, he 
was attacked by the mercurial eruption, merely 
from sleeping in the same bed with a person who 
was using mercurial frictions. 

I now directed him to apply bread and water 
poultices to the ulcer, and to continue his medicines 
as before directed, under which treatment he gradu- 
ally amended. 

On the 9th of May, a few scabby ulcers had ap- 
peared on the scrotum, and I was induced to try 
the antimonial pills with calomel. He took but 
one of these ^t night, which contained only half a 
grain of calomel, and two grains of antimonial pow^- 
der, and he called on me the next morning to show 
me his skin covered with the red suffusion, which 
he knew to be a fresh attack of the mercurial dis- 
ease. The pills were, of course, discontinued, and 
under the use of sarsaparilla, his complaints all dis- 
appeared about the middle of the ensuing May. 



1 58 * PUSTULAR VENEREAL DISEASE. 

All eruptions, venereal or not venereal, imper- 
ceptibly glide into those of the nearest character; 
and it often happens, that practitioners can only 
determine the nature of the eruption for which he 
is called upon to prescribe, by an attentive consi- 
deration of its progress. Thus the chicken-pock, 
which is a vesicular eruption, is often found (to the 
great perr/iexity of the profession of late) to contain 
pustules so large and so closely resembling those of 
small-pox, that it is only by attending to the pro- 
gress of the eruption, and, perhaps, its termination, 
that the one can be distinguished from the other. 

On the contrary, small-pox often exhibits so 
many papulae and vesicles, or half formed pustules, 
that the character of the disease is not very easily 
distinguished, ev^en by the most experienced practi- 
tioner, until its progress determines its nature. But 
the more experience a practitioner possesses in such 
cases, the more readily is he enabled to form his 
diaonosis. The comm.on itch is a disease which 
exhibits three orders of eruptions at the same time, 
viz. pustules, vesicles, and papulae ; and yet the ge- 
neral character of the disease is so obvious, that al- 
most any person can, without hesitation, decide upon 
its nature. In the sauie manner venereal eruptions 
are sometimes obser7ed to glide into those of the 
nearest character; tbus the papular eruption may 
exhibit a fev/ pustules, which, like the pustular ve- 
nereal eruption, form thin crusts instead of ending 
in desquamation; but still the character of the 
disease is so apparent, that there is not by any 
means the same degree of ambiguity which attends 



PUSTULAR VENEREAL DL^EASE. 159 

the variolous and varicellous diseases ; and in the 
same way the pustular disease may exhibit papulse 
among its pustules, to which the same observations 
maybe applied; but this practical one is worth add- 
ing, viz. that the more closely the erupimi ap- 
proaches in thefonn ofpapulce, terminaling in des- 
quamation^ so much the more mild, yielding, and 
manageable, will the disorder befoimd. 

The phlyzacious pustules, which have been ob- 
served to arise from the ulcer with elevated edges, 
all terminate in superficial sores covered with thin 
scaly crusts ; 5^et although a few pimples may be 
intermixed with these pustules, the general charac- 
ter of the eruption is sufficiently obvious to evince 
its pustular nature. 

The general mildness of the eruption and of the 
ulcers which it produces, compared w^ith the thick 
crusts and spreading ulcers with phagedenic mar- 
gins of the phagedenic disease, sufficiently points 
out the distinction between them. 

The eruption which I attribute to the ulcer with 
elevated edges, often exhibits at the same time on 
the same individual new formed pustules ; others in 
their scabbing stage, with an intermixture of small 
ulcers whose crusts have fallen off, and of disco- 
loured patches of skin where they have healed; so 
that nothing can be more disgusting than the ap- 
pearance of a patient under those circumstances. 

In this state of the surface, there is nothing more 
efficacious for clearing the skin of all this foulness, 
than sulphur fumigations. Baths impregnated with 
sulphurated kali, and the nitromuriatic acid baths 



160 PUSXCLAR VENEREAL DISEASE. 

are also useful, but not equally efficacious with the 
sulphur fumigations. Smearing the body with equal 
parts of tar and sulphur ointments is also of service: 
with these applications I also combine the internal 
exhibition of antimonials and sarsaparilla. The fol- 
lowing case elucidates the efficacy of the treatment 
recommended. 

Case 13. — Thomas Watson, admitted July 11th, 
1815, with numerous ulcers varying from the size 
of sixpence to a shilling over his entire body, some 
of which were covered with flat crusts. He stated 
that he was disordered three years and a half, the 
first appearance of his ailments being an ulcer on 
the penis which healed with great difficulty under 
the use of mercury, having been four months in the 
Lock Hospital constantly using mercurial frictions; 
but notwithstanding the severity of the course he 
underwent, that a month after he left the hospital 
his throat became affected, and afterwards the erup- 
tion appeared, for which, with little interruption, he 
had been using mercury to the time of his admis- 
sion. His emaciation was extreme. 

I directed for him a strong decoction of guaiacum 
wood, conjoined with the antimonial solution, which 
he continued to take until the 14th August. Dur- 
ing this period the majority of the ulcers had heal- 
ed, but some new spots appearing, I discontinued 
those medicines for the nitrous acid, which he took 
until the 11th of September, but it disagreeing with 
his bowels, the compound decoction of sarsaparilla 
was ordered in its place. The eruption of pustules^ 
which formed thin crusts, and then healed, con- 



PUSTULAR VENEREAL DISEASE. 161 

tinued until the beginning of October. Decided 
benefit was derived from smearing them daily with 
equal parts of the tar and sulphur ointments. He 
continued the decoction until the 23d of October, 
when he was discharged well. 

The pustular venereal disease, both in its primary 
and secondary symptoms, forms the natural link 
between the papular and phagedenic venereal dis- 
eases. 

It is more obstinate and inveterate than the pa- 
pular, but in no instance possesses the malignity 
and destructive tendency of the phagedenic. The 
reader need only contrast its symptoms with those 
of the papular disease, to observe the wide distinc- 
tion between them. 

We shall defer comparing them with those of the 
phagedenic disease until the latter has been con- 
sidered. 



CHAPTER V. 

PHAGEDENIC VENEREAL DISEASE. 

In this chapter, I purpose to enter on the consid- 
eration of the third class of primary diseases, which 
have been confounded with syphilis, viz. the phage- 
denic ulcer, and the sloughing ulcer, together with 
the constitutional symptoms arising from both spe- 
cies. 

The phagedenic ulcer, as its name implies, has a 
corroded appearance, and neither exhibits granula- 
tions, or surrounding induration. It spreads some- 
times with rapidity, causing the most destructive 
havoc in the course of a few days; and in other in- 
stances creeps on slowly, healing in one part and 
making progress in another; but unlike a chancre, 
instead of being checked by mercury, it is almost 
always rendered more inveterate and rapid in its 
progress by that mineral. It more frequently at- 
tacks the glans penis than any other part; but the 
ulcer usually proceeds to affect the prepuce, which 
it often entirely consumes, and continuing its depre- 
dations on the corona and glans, at last effects their 
total destruction. When this event takes place, the 
ulceration usually receives a sudden and permanent 
check. At other times, a spontaneous hemorrhage, 
owing to the destruction of the coats of an artery, 
occasions a favourable change. The hemorrhage 



PHAGEDENIC VENEREAL DISEASE. 163 

from this cause is often so profuse, that I have fre- 
quently found the patient's bed-clothes drenched in 
blood ; and in many instances found it necessary to 
sjtop the hemorrhage by ligature. It is an occur- 
rence, however, that is in general fortunate to the 
patient, for in those cases the ulceration is often stop- 
ped in its progress by this cause alone. More rare- 
ly it happens, that notwithstanding every anodyne, 
and lenient application, the ulceration will gradual- 
ly proceed, until the entire penis is destroyed. 
There is also another characteristic of this ulcer 
worthy of remark, viz. the frequent return of ulcer- 
ation, after the part has healed, to the very same 
spot which was at first affected. 

Notwithstanding the vast number of cases of the 
phagedenic ulcer which came under my observation, 
1 never yet had an opportunity of seeing it at its com- 
mencement, so that I am still ignorant whether it 
arises from pimple, pustule, or vesicle ; or whether 
it passes immediately from its commencement into 
its phagedenic state. I have, however, observed in 
two or three instances, that before it decidedly as- 
sumes this character, it appears as a small excava- 
ted ulcer covered with white adhesive matter ; and 
it is probable that in this stage, by the application 
of escharotics, it is as capable of being healed as 
any other primary venereal ulcer, before it passes 
into the phagedenic state. 

The sloughing ulcer is still more untractable and 
destructive than the phagedenic : but the surgeon 
has seldom an opportunity of seeing its commence- 
ment, as the disease excites so little uneasiness at 



164 PHAGEDENIC VENEREAL DISEASE. 

first, that, in general, its attack is unobserved even 
by the patient, until it has existed for several days. 
A small black spot that resembles a grain of shot in 
colour as well as in size, is its first appearance; 
which if seen by the experienced eye of a surgeon, 
even at this early period, will at once be recognised 
as a slough or mortification, extending to some 
depth below the surface. The slough will continue 
to increase sometimes to only three or four times 
its original extent, and at others until it engages a 
considerable portion of the penis, before a line of 
separation can be observed between the living and 
mortified parts. When the separation at length 
takes place, we do not find a clean granulating sore, 
as occurs in simple mortification; but a corroding 
phagedenic ulcer, which begins a new kind of de- 
predation on the surrounding parts, equalling the 
virulence, but not the rapidity of the sloughing pro- 
cess, by which it was preceded.^ 



* It is probable that the sloughing and phagedenic forms owe 
their origin more to circumstances of which the climate, constitu- 
tion and habits of the patient are the principal, than to a distinct 
and specific virus. A southern climate predisposes most to these 
forms of syphilis, which are comparatively rare in the more north- 
ern and temperate latitudes. These remarks will perhaps apply 
with most force to the sloughing ulcer, of which the editor has 
seen but few cases in Philadelphia. In the south of Europe, the 
predisposing causes seem to be far more active, and particularly 
so in their operation upon northern visiters. The crews of our 
men of war and merchantmen, have occasionally suffered very 
much from this form of syphilis in the Mediterranean, especially 
on their visits to the Italian and Spanish ports. As yet the most of 
our information upon this subject has been acquired through the 
medical attendants of the British army and navy, who were con- 
cerned in the Peninsular war. From their testimony v,^e think it 
may be inferred, that the same cauv«es which rendered all kinds 



PHAGEDENIC VENEREAL DISEASE. 165 

Suddenly those parts are attacked by severe pain, 
and afterwards assume a bluish cast, and on the fol- 
lowing day they are found to be covered by a slough; 
and in this way this destructive malady continues 
to extend its ravages by alternate sloughing and ul- 
ceration, until in one sex the entire penis, scrotum, 
perineum andpubes are destroyed; and in the other, 
until the labia, nymphse, vagina, anus, nates, and 
1 believe even the bladder and uterus, are engaged 
in one extended and malignant state of putrefaction. 

But if the ulcer is fortunately stopped in its pro- 
gress, and a portion only of the penis is destroyed ; 
the orifice of the urethra becomes so contracted in 
the new formed cicatrix, that the urine passes with 
the greatest difficulty, unless the utmost care is ta- 
ken to preserve the passage open during the heal- 
ing of the ulcer. These circumstances are noticed 
by the accurate Celsus, who describes a certain 
blackness, which, though it does not excite pain, 
gradually spreads; and if we do not resist it, makes 
its way to the bladder, when no assistance can be 
given. His manner of treating this ulcer is by the 
application of the actual cautery, if it is confined to 
the glans penis ; but first he directs a small probe 
to be introduced into the urethra, in order to pre- 
vent that passage from closing. If however the ul- 
cer has penetrated far, he recommends the excision 



of wounds more dangerous to the British soldiers than to the na- 
tives, led to the gangrene, sloughing and horrid consequences 
which so often befel them. It is this form of syphilis which in 
the south of Europe has acquired the popular character of a new 
and distinct disease, under the frightful appellation of the Black 
Lion, E. 



166 PHAGEDENIC VENEREAL DISEASE. 

of such parts as are engaged in the disease; and to 
be treated afterwards in the same manner as other 
gangrenes.* 

The phagedenic and sloughing ulcers may, in 
most instances, be readily distinguished from all 
others, after they have assumed their peculiar cha- 
racters. But the former does not immediately, on 
its first commencement, assume its phagedenic 
character. . Some difficulty in this early stage (as 
occurs in the early stage of all morbid poisons) may 
arise in distinguishing it from the other primary 
ulcers, to which the generative organs are subject. 
It, however, displays its peculiar character of pha- 
gedena so early, that, I conceive, it cannot often 
happen that embarrassment will arise, by confound- 
ing it with an ulcer that becomes phagedenic from 
irritation, for it must be recollected that neglect, 
local irritation, and I will even add, (although it may 
seem to favour the opinion of my adversaries,) ex- 
cessive constitutional irritability, will cause a vene- 
real ulcer, as it will any other, to become phage- 
denic, however originally mild in its nature. It must 
therefore be in the highest degree useful to attend 
to the progress of an ulcer, and, if possible, to as- 
certain whether it assumes the phagedenic charac- 
ter soon after its commencement or not ; and if not. 



* Q,UtEdam etiam nigrities est, quse non sentitur, sed serpit, ac, 
si sustinuimus, usque ad vesicam tendit ; neque succurri postea 
potest. Si id in summa glande circa fistulam urinse est, prius in 
earn tenue specillum demittendum est, ne claudatur ; deinde id 
ferro adurendum : si vero alte penetravit, quidquid occupatum est, 
prsecidendum est, cetera eadem qux in aliis cancris, facienda sunt. 
— Lib. vi. Sect. 18. 



PHAGEDENIC VENEREAL DISEASE. 167 

it is not to be classed with that venereal disease 
which I have termed phagedenic. 

These characters of the different primary vene- 
real ulcers already noticed, are, I trust, suflGiciently 
obvious to enable us, in the great majority of cases, 
to distinguish the commencement of diseases, which 
take very different courses, and require, in many 
respects, different modes of treatment. 

Mercury improperly exhibited, neglect, irritation 
and imprudence of various kinds on the part of a 
patient, may so irritate and inflame an ulcer as to 
render it impossible to decide on its character, until 
this adventitious inflammation is removed. The 
same diffinulty may arise from the same cause, in 
enabling us to decide from appearances, whether a 
patient has been inoculated with the vaccine or va- 
riolus matter, although nothing can be more distinct 
than the characters of their respective primary ul- 
cers (if I may be allowed the term) when not thus 
affected. 

Inflammation thus occurring on primary venereal 
ulcers, often excites mortification of the part; but 
then mortification or slough thus produced, is to- 
tally different from that which affects the venereal 
sloughing ulcer. In the former instance when the 
sloughs separate, a clean granulating sore is expos- 
ed; and in the other a phagedenic surface, which 
proceeds alternately sloughing and ulcerating, as 
long as the disease continues. 

As far as my experience extends, buboes are 
more infrequent in this form of venereal disease 
than in any other. Before ulceration they do not 



168 PHAGEDENIC VENEREAL DISEASE. 

exhibit any peculiar characters, but afterwards they 
partake of the general malignity of the disease. 

The edges of the ulcer become undermined, 
jagged, and irregular ; and there is no chance of in- 
ducing them to cicatrize until these projecting edges 
are removed, which may be done either with caustic, 
or the knife ; — the latter is the mode I always prefer 
as the least painful and tedious. 

The constitutional Symptoms of the phagedenic 
and sloughing ulcers are, 

First, An eruption of tubercles, pustules, or spots 
of a pustular tendency, which quickly degenerate 
into ulcers covered with thick crusts, that usually 
heal in a peculiar manner from the centre, while at 
the same time they are extending at their circum- 
ference with a phagedenic border. This eruption 
is often ushered in by a high degree of fever, which 
is lessened, but not altogether removed on the ap- 
pearance of the eruption. Sometimes the patient 
will complain of being generally unwell, for a con- 
siderable period preceding the eruption, without be- 
ing able to state any particular symptoms to account 
for his indisposition: however, a general listlessness, 
pallid countenance, languid eye, and broken rest, 
sufficiently evince that he is neither fanciful or 
hypochondriacal. 

In other instances, severe nocturnal head-achs, 
with tenderness of the scalp, or slight dyspnoea, 
with tenderness of the sternum upon pressure, and 
general soreness of the chest, afford to the wary 
practitioner the first intimation that a venereal taint 



PHAGEDENIC VENEREAL DISEASE. 169 

may be present, and induce him to make further in- 
quiries bearing upon this point. The premonitory 
symptoms may undoubtedly usher in the eruption 
of any of the other forms of venereal disease, but 
repeated observation enables me to state, that they 
are more severe in the phagedenic, than in any 
other form of venereal complaint. 

Plates III. and IV. and fig. 4, 5, 6. Plate I. show 
the different appearances of this eruption, and the 
general form of the crusts, better than any descrip- 
tion. I do not say that in every instance, the crusts 
which form on the spots assume the conical figure, 
which bears a close resemblance to the Rupia pro- 
minens, delineated in Bateman ; nor that the ulcer 
always heals at its centre, while it is spreading with 
a phagedenic margin. But I beg to state, that these 
appearances with which accidental occurrences may 
occasionally interfere, are the usual characteristic 
signs of this disease. It has been suggested to me 
by my former pupil, Mr. Farrel, (now a member of 
the Dublin College of Surgeons,) who noted almost 
all the cases in my first edition, that the circumstance 
of the ulcer healing in this manner, may be owing 
to the destruction of the cutaneous structure in its 
centre, and that the skin being here destroyed, the 
parts underneath throw out granulations, which 
soon cicatrize, while at the same time the ulcer 
continues to make progress at its circumference, in 
accordance with the pathological law, so well esta- 
blished, that diseased affections as well as inflam- 
mation, extend in the direction of the tissues they 



170 PHAGEDENIC VENEREAL DISEASE. 

first attack, leaving untouched other tissues in their 
immediate vicinit}^ 

If, therefore, this peculiar mode of healing de- 
pends upon the destruction of the cutaneous tissue 
in the centre of the ulcer, it is obvious that though 
a frequent occurrence, it does not constitute an in- 
dispensable character. An ulcer which heals in 
this manner sometimes spreads to an enormous ex- 
tent. I have in my possession a drawing of one 
taken from a patient in the Richmond Hospital, 
which commenced on the arm, and extended over the 
shoulder and those integuments of the back which 
cover the scapula, exhibiting a great extent of red, 
shining, new-formed skin, surrounded by a border 
of phagedenic ulceration, from half an inch to an 
inch in breadth. 

Second. — ^The ulceration of the throat which at- 
tends the phagedenic disease, is of a most formi- 
dable nature^; according to my experience, it com- 
mences in the form of a small white apthous-look- 
ing sore, which usually attacks the velum, or pos- 
terior part of the pharynx, but more frequently the 
latter. It sometimes, but more rarely, commences 
in other parts of the throat. If not checked in its 
progress, wherever it may arise, it rapidly engages 
the entire of the pharynx ; extending upwards the 
nares become affected, followed too frequently by 
caries, and exfoliation of the spongy bones, and ten- 
derness of the ossa nasi, with a foul discharge from 
the nostrils. This ulcer, in its progress towards 
the mouth, also affects the tonsils with a similar ul- 
ceration ; and seizing upon the velum, and uvula. 



PHAGEDENIC VENEREAL DISEASE. 171 

rapidly destroys them. So that in looking into the 
mouth of a person in this lamentable state, there 
appears one vast continuous ulcerated cavity, cov- 
ered with a white viscid matter, and extending from 
the palate to the lower part of the pharynx. 

If it should, as is frequently the case, extend 
downwards to the larynx, there will be but little 
chance of saving the patient's life. When this or- 
gan is attacked, we are soon apprized of the circum- 
stance, by a most distressing train of symptoms : — 
viz. a whispering stridulous voice, constant cough 
and copious expectoration of viscid matter, attended 
with restlessness, great anxiety of countenance, 
emaciation, night-sweats, rapid pulse, and all the 
concomitants of phthisis. 

When the epiglottis has been in part or entirely 
engaged in the process of ulceration, it is no longer 
capable of performing the office of a valve. Fo- 
reign bodies, therefore, slip into the trachea as often 
as the patient attempts to swallow, and excite vio- 
lent irritation and fits of coughing that threaten the 
life of the patient. I have known two instances of 
sudden death to occur in the Lock Hospital from 
this cause. In general, however, the patients linger 
many months, and at length die consumptive. I 
never yet witnessed a recovery where the larynx 
was decidedly attacked with ulceration, although 
mercury, cicuta, opium, blisters, and a variety of 
other means were employed. 

The extension of the ulcer to the nares may be 
suspected if the patient's breath becomes offensive, 
with an obstruction of breathing through his nose; 



172 PHAGEDENIC VENEREAL DISEASE. 

and amounts to certainty, if a foul discharge, occa- 
sionally tinged with blood, comes from the nostrils. 
The disease will afterwards become apparent by 
exfoliations of the bones, and a sinking in of the 
cartilage. 

In the several cases of venereal affection of the 
nose which came under my observation, it was ob- 
viously a symptom of the form of venereal disease 
now under consideration, and could readily be traced, 
in most instances, to the phagedenic primary ulcer. 
I never witnessed an instance of this affection of 
the nose conjoined with the papular eruption, or the 
scaly syphilitic lepra, or psoriasis ; but in every in- 
stance in which an eruption was also present, it was 
of the pustular description, and had either formed 
scabs or ulcers. 

The frequency of venereal affections of the nose, 
and consequent deformity among the inhabitants of 
Lisbon, has been observed by the surgeons of our 
army who served in Portugal ; and this circumstance 
may, with tolerable certainty, be ascribed to the 
great prevalence of the phagedenic and sloughing 
ulcers in that country. 

Third. — At the same time that the patient is af- 
fected with the eruption and ulceration I have de- 
scribed, he is in general attacked with severe and 
obstinate pains in his joints; particularly in his 
knees, wrists, and ankles, which often become swell- 
ed, red, and so painful, that they are highly sensi- 
ble to the slightest touch. The affection of the 
knee is usually attended with considerable swelling, 
and every symptom that denotes an acute attack 



PHAGEDENIC VENEREAL DISEASE. 173 

of inflammation of the synovial membrane. This 
affection of the knee is so frequent an occurrence 
in this form of venereal disease, that it may be al- 
most esteemed one of its peculiar characters. 

Fourth. — Nodes were only traced to the phage- 
denic primary ulcer, in such cases as were treated 
with mercury. Both Mr. Guthrie and Mr. Rose 
have stated the remarkable infrequency of this symp- 
tom in numerous cases, which were treated without 
that medicine. The question therefore, whether 
they occur in this form of disease where mercury 
has not been exhibited, remains to be decided ; but 
in the whole of my experience, I have not seen an 
instance of nodes attendant on the phagedenic ve- 
nereal disease, except where mercury had been 
previously administered. 

Obstinate enlargement of the testes is also not of 
unfrequent occurrence in this form of the disease, 
but whether it appears where mercury has not 
been exhibited, I cannot take it upon me to deter- 
mine. 

Many anomalous symptoms, such as large indo- 
lent swellings, containing a serous fluid, may occur. 
I have not, however, seen them in any cases, except 
those where mercury had been largely employed; 
so that we have as much reason to attribute them 
to the agency of the medicine, as to that of the 
morbid poison, or more probably to the combined 
effects of both. In fact, the train of symptoms I 
have been endeavouring to describe, is so very of- 
ten found to be injured, rather than benefitted by 
the exhibition of mercury, that we may well ascribe 



174 PHAGEDENIC VENEREAL DISEASE, 

to this circumstance, the coinage of the favourite 
terms mercurial (in the unrestricted sense in which 
it is employed,) syphiloidal, sequelse of syphilis, &c. 
the anomalies presented by this disease, under the 
mercurial mode of treatment, first impressed my 
mind with the necessity of that investigation, which 
has been of so much public advantage ; and I am 
persuaded, that these very perplexities have induc- 
ed others to lend their energetic assistance to as- 
certain how far venereal complaints can be com- 
batted without the exhibition of mercury : an inves- 
tigation, which, in spite of the common-place decla- 
mation and untractable dogmatism of professional 
bigots, has already led to an improved line of prac- 
tice, and conferred the most important benefits upou 
society. 

I am satisfied that there is not an experienced 
member of the profession who w^ill not admit, that 
the group of constitutional symptoms I have de- 
scribed in this chapter, frequently resist the effects 
of reiterated courses of mercury; and that even 
while the patient is under the fullest influence of 
that medicine, but most usually afterwards, new 
symptoms not before observed will occur, and par- 
ticularly nodes. But such is the apparent perversity 
of this disorder, it must still be acknowledged, that 
after repeated courses of mercury have failed, the 
patient will sometimes recover under a new trial of 
the medicine, and that at a period when his hopes 
and his strength have been nearly exhausted. — 
These facts are so common, that they scarcely re- 
quire to be elucidated by cases. I shaU, however, 



PHAGEDENIC VENEREAL DISEASE. 175 

subjoin a few, in order to render my views more 
perspicuous to the juniors of the profession. 

I have not a doubt but that the embarrassing ob- 
stinacy of this disease perpetually arises from the 
premature and indiscreet interposal of mercury, 
which interrupts and encumbers its natural pro- 
gress. The vulgar often make use of terms which 
have originated from a close observance of nature, 
and I cannot but attribute to this source the very 
frequent expression, " the disorder has been set 
astray^'' which is usually applied to the untoward 
symptoms that occur in small-pox, measles, or scar- 
latina, when the eruption suddenly recedes. It is 
also applied to the unexpected attacks of venereal 
secondary symptoms, when the constitution is under 
the influence of mercury. In the morbid poisons 
first mentioned, we know that on the re-appearance 
of the eruption, those dangerous symptoms which 
arose from the affection of some of the internal or- 
gans, and threatened the life of the patient, imme- 
diately decline ; and if we may recur to analogical 
reasoning in aid of our experience, the propriety of 
being guided by those facts in the treatment of the 
embarrassing malady under consideration will not 
be disputed. 

I may, therefore, be permitted to argue, that the 
mercury which interrupts the natural progress of 
this morbid poison, and often removes the eruption 
and heals the constitutional ulcers of the skin and 
throat, transfers the disease to the deep seated parts 
— the periosteum, fascia, and bones ; and that this 
is the true reason that we so frequently witness the 



176 PHAGEDENIC VENEREAL DISEASE. 

occurrence of nodes and other affections of the deep 
seated parts after the patient has undergone the 
fullest influence of mercury, and flattered himself, 
in the disappearance of the disease from his skin, 
that it has been altogether subdued in his system. 

I am still farther supported in this inference by 
the fact already adverted to, that the bones are sel- 
dom or never affected in those who have not used 
mercury. Nor are we to forget in the argument, 
our knowledge of the proper treatment for the yaws, 
between the symptoms of which and the disease 
under consideration, there exists the most striking 
similarity. 

In both, the eruption is ushered in by pustular 
spots which scab and terminate in ulceration. In 
both the ulcers of the throat are equally severe and 
malignant. In both, pains of the joints accompany 
the eruptions. In both, the disease will recur again 
and again after the use of mercury : and in both, 
after the exhibition of that medicine, the bones are 
particularly liable to be affected. When the yaws 
first became known to our West India practition- 
ers, mercury was exhibited in every case ; but it is 
now as universally abandoned from the dear-bought 
experience, that it renders the disease nearly in- 
curable, and particularly if exhibited before the 
eruption is in the scabbing stage, or the disease 
manifestly on the decline. But, on the contrar}^ 
if the yaws are allowed to pursue their natural 
course, the disease will wear itself out, or in other 
words, yield to the powers of the constitution in the 
course of a few months. If it were riot condescend- 



PHAGEDENIC VENEREAL DISEASE. 177 

ing too far, our practitioners might have acquired 
all the information that vi^as necessary on the sub- 
ject from the uncultivated natives of Africa, who 
effectually cure the disease without recurring to 
mercury. 

Destructive as the phagedenic ulcer is, it will 
yield to those means calculated to remove pain and 
inflammation. Absolute rest in the recumbent po- 
sition; venesection, in proportion to the extent 
of the pain, inflammation, and symptomatic fever ; 
antimonials, in sufficient doses to nauseate ; warm 
poultices of bread and water ; warm fomentations, 
either in the form of stupe, or injected between the 
prepuce and glans; opium, hyoscyamus, and cicuta, 
in sufficient doses to lessen pain and irritation, and 
procure rest at night, are the means upon which I 
rely during the inflammatory and more active stage 
of the phagedenic ulcer. Afterwards, when it ex- 
cites but little uneasiness, and creeps slowly along, 
healing in one place while ulcerating in another, the 
solution of nitrate of silver, in the proportion of one, 
two, or three grains to an ounce of distilled water, 
may be of service ; or the mercurial black or yel- 
low washes agree well in some cases, while in oth- 
ers, it must be admitted, that no application seems 
to check the progress of the ulcer. In such cases, 
a spontaneous haemorrhage, which is sometimes 
very profuse, often gives an immediate check to the 
disease. From having observed this favourable 
result of haemorrhage, I have been induced, in 
Some instances equally inveterate, to imitate the 
process of nature ; and at the same time, remove a 

z 



178 PHAGEDENIC VENEREAL DISEASE. 

diseased surface, by paring off the irregular and 
jagged superfices of the ulcer, and encouraging the 
bleeding afterwards, by immersing the part in warm 
water. And I have had the satisfaction of frequent- 
ly witnessing the most beneficial effects from a 
measure apparently severe, but w^hich w^as followed 
by cessation of pain, and the rapid amendment of 
the ulcer thus treated. 

Sometimes, w hen the ulceration is extensive and 
irregular in the chronic stage of the disease, irrita- 
tion is kept up by a band of integument, connecting 
one portion of the ulcer to another, and acting like 
a bridle on the part. A practitioner accustomed to 
those cases will, at a glance, perceive that ulcera- 
tion will go forward until this connecting band is 
destroyed. I therefore, always anticipate the slower 
and more painful process of nature, by dividing 
the band in question ; and irritation being thus less- 
ened, immediate amendment most commonly fol- 
lows. In the same way, when an ulcer attacks the 
frenum, no matter what its character may be, it 
usually continues to extend until it eats through the 
part; and, for the reasons mentioned, in such cases 
I am in the habit of dividing the frenum with a sharp 
pointed bistoury, which is very generally followed 
by an immediate cessation of the ulcerative process. 

Stimulating applications are often extremely use- 
ful to sloughing venereal ulcers, such as Venice tur- 
pentine, or balsam copaivse, blended with one or two 
parts of olive oil. 

I have frequently seen very extensive ulcers on 
the penis or groins, which were spreading rapidly, 



PHAGEDENIC VENEREAL DISEASE. 179 

checked by either of th^se applications, and exhibit 
in a few days, a clean granulating surface. 

I have not observed any advantage to result from 
the use of emollient or fermenting poultices in this 
description of ulcer. When the sloughs are exten- 
sive the terebinthinate applications just mentioned, 
or a lotion composed of one part of tincture of myrrh 
to seven of camphorated mixture, have been attended 
with much more benefit. They correct the foetor of 
the sloughs, and stimulate the sound parts to cast 
them off, but unfortunately it has not the power of 
preventing their, renewal. Change of air, in every 
instance in which I tried it, was attended with de- 
cided advantage ; I am so fully assured of the bene- 
fit to be derived from this source, that the first 
thing I should recommend on being consulted by a 
patient affected with a sloughing ulcer, would be 
his removal to the country. 

Bark appears to me to be injurious in this ulcer. 
I never observed any amendment under its use; 
button the contrary, found that the ulcer always 
rapidly extended during its exhibition. Indeed, 
from the high degree of fever present, we might, a 
priori^ conclude that bark would not be serviceable. 
The pulse is in general from 100 to 130; and when 
the ulcers are very extensive, the tongue is dry, 
brown, or even black, such as it appears in the ad- 
vanced stage of typhus fever. A contrary mode of 
treatment seems to be indicated by the fact that a 
spontaneous haemorrhage from the ulcer, frequently 
induces a favourable change. The exhibition of 
opium or cicuta in large doses, has frequently been 
attended with the most decidedly cood effects. 



180 PHAGEDENIC VENEREAL DISEASE. 

When the ulcer has gained considerable ground, 
we should entertain but a very unfavourable prog- 
nosis of the event. Thus, if the ulcer has already 
destroyed one half of the penis, the most judicious 
treatment will scarcely save the remainder, or pre- 
vent the scrotum from falling into mortification; in 
which case the patient (if he can think himself so) 
will be fortunate in escaping with life. But if only 
a part of the prepuce or glans is engaged in the ul- 
cer, however alarming the state of the patient, we 
may hope, under judicious management, to retrieve 
him from his perilous situation. 

It may be useful to illustrate the plan of treatment 
recommended for these ulcers, by a very few cases. 

Case 15. — William Brady, admitted October 26th, 
1814. An extensive phagedenic ulcer, engaging 
the prepuce, corona, and a large portrbn of the body 
of the penis, which was nearly encircled by the ul- 
cer, and was swollen to a great extent by inflamma- 
tion. His pulse 120 — thirst and restlessness. 

He stated that he was four months disordered, 
and was the entire of that period using mercury, 
both in the form of pill and ointment. 

Sixteen ounces of blood were immediately taken 
from his arm, and the vensesection was repeated on 
the following day. Nauseating doses of tartar-emetic 
were also directed, with warm fomentations and 
bread poultices. 

November 7th. The inflammation and symptom- 
atic fever lessened. — Ext. Cicutse. gr. v. ter. die. 

22nd. Ext. Cicutse. gr. x. ter. die. 

Under this plan he remained until the ulcer was 
nearly healed. 



PHAGEDENIC VENEREAL DISEASE. 181 

December 12th. Discharged well. 

Case 16. — Michael Cleary, admitted December 
19th, 1814. The entire prepuce either presenting 
a sloughing or a phagedenic ulcerated surface. The 
glans penis could be seen in a similar sloughing and 
phagedenic state, projecting through the ulcerated 
edges of the prepuce. The entire penis swollen and 
inflamed — pain excessive — high symptomatic fever, 
pulse 120. 

He stated that the ulcer first appeared on the 
glans about a month before his admission, and that 
he had rubbed in fourteen drams of mercurial oint- 
ment. — ^Mitt. Sanguis ad. §xvi. — SolutAntim. — Fo- 
tus — Catapl. 

20th. Repet. vensesect. 

26th. The greater portion of the glans was evi- 
dently in a state of slough. 

January 2nd. The entire glans and prepuce had 
separated. Pain and symptomatic fever reduced. — 
Ext. Cicutse. gr. v. ter. die. The ulcer now healed 
so rapidly, that it was necessary to introduce a piece 
of bougie into the urethra in order to keep that pas- 
sage open. 

January 29th. Discharged well. 

The loss of the glans and prepuce in this case 
might have been prevented if the depleting plan had 
been employed instead of mercury,' before his ad- 
mission. 

Case 17.— Stephen Mulligan, March 2nd, 1815. 
A phagedenic ulcer which engaged the entire of the 
upper surface of the glans, attended with swelling 
and inflammation of the penis. A foul ulcerated 



182 PHAGEDENIC VENEREAL DISEASE. 

bubo with projecting edges in the left groin. He 
was two months disordered and had not used mer- 
cury. Solut. Antim. — Fotus — Catapl. 

6th. — The inflammation of the penis had increas- 
ed, and the ulcer was extending. Mitt. Sanguis ad 
|xvi. 

8th. — ^Repet. vensesectio. — Med. ut antea. These 
depletions almost ijnmediately relieved the pain 
and inflammation. 

April 3d. — The ulcer was healing round the 
edges. 

17th. — The ulcer was healed, leaving a deep in- 
dentation in the glans. Thus afibrding an instance 
of the rapid mode in which the ulcers of some mor- 
bid poisons heal without any regeneration of the 
parts destroyed, a circumstance first noticed by 
Doctor Adams. 

The bubo was not healed until the 4th of June, 
when he was discharged the hospital. During the 
last month he took daily decoction of sarsaparilla. 
Case 18. — Patrick Kearns admitted Dec. 16th, 
1815. A phagedenic ulcer which had destroyed 
the entire prepuce and a great portion of the glans, 
and was extending its ravages to the body of the 
penis; pain severe; symptomatic fever consider- 
able. — There was frequent haemorrhage from the 
ulcer which he was desired to encourage whenever 
it occurred, by bathing the part in warm water. 

He had been but three weeks disordered, and 
had only taken six mercurial pills. Solut. Antim. — 
Fotus.— Catapl. 

18th.— The haemorrhage from the ulcer was con- 



PHAGEDENIC VENEREAL DISEASE. 183 

siderable, the pain was lessened, and the ulcer ap- 
peared less irritable. 

January 15th. — The ulcer was healing, but the 
body of the penis was swollen, hard, and cedema- 
tous, which induced me to suspect that matter had 
formed under the ligamentum penis, which, on ex- 
amination, was found to be the case, as the probe 
was easily made to pass from the ulcer of the coro- 
na towards the pubis under the ligament. This 
was immediately dilated, and gave exit to an accu- 
mulation of matter. The ulcer improved but slow- 
ly, and did not heal until the 4th of March, when 
he was discharged. 

Case 19.— Thomas Farrell, Feb. 7th, 1816. One 
half of the glans penis engaged in a phagedenic 
ulceration, the edges livid and irregular, the re- 
mainder of the glans was seamed with the cicatrices 
of preceding ulcers, the consequences of the same 
infection — one part healing, while the ulceration 
broke out in another; pulse, 112; thirst and general 
fever. 

The ulcer was first observed in the preceding 
August, and from that time to the period of his ad- 
mission he was using mercury in the form of pills 
and rubbings, under different practitioners, which 
kept his mouth constantly sore. Mittr. Sanguis ad 
|xvi. Solut. Antim. — Fotus, — Catapl. 

8th, — Pain more severe ; the inflammation of the 
penis increased; pulse, 126. Repetr. Vensesect. — 
Opii gr. ii. o. n. — Solut. Antim. ut an tea. 

12th. — Pain and symptomatic fever as before. 
Repetr. Vensesect. 



184 PHAGEDENIC VtoEREAL DISEASE. 

20th. Pulse, 112; pain somewhat lessened ; a pro- 
jecting portion of the glans, which was undermined, 
and rendered jagged by the ulceration, was remov- 
ed by the knife, and the bleeding afterwards en- 
couraged by warm water. 

March 4th. — -The patient had the inprudence to 
leave his bed, which excited a renewal of the pain 
and inflammation; pulse, 130. Mittr. Sanguis ad | 
xvi. 

14th. — The inflammation and swelling removed ; 
the ulcer much improved. 

April 8th. — Ulcer healed. Discharged the hos- 
pital. 

Case 20.— -Mr. N. put himself under my care on 
the 3d of November, 1817, on account of a phage- 
denic ulcer of the frenum and adjoining surface of 
the glans. He had not used mercury. I divided 
the ulcerated frenum with a bistoury in order to 
check the irritation, which I knew from experience 
it would otherwise keep alive. Extract Cicutse gr. 
V. ter. die. Lot. Hydrarg. Nigra. 

December 4. — The ulcer healed. 

In compliance with this gentleman's wishes, after 
the ulcer had finally healed, I indulged him in an 
alterative mercurial course, conjoined with decoction 
of sarsaparilla for three weeks. 

I shall not fatigue my reader by adding farther 
instances of the phagedenic ulcer and the mode of 
treatment which has been so decidedly successful. 
I shall only entreat of every man of experience and 
candour to contrast them wuth those of a simi- 
lar character which have come under his notice, 



PHAGEDENIC VENEREAL DISEASE. 185 

and were treated with mercury ; and I shall confi- 
dently abide the result of the comparison in the 
decision of such a man between the two modes of 
practice. 

Case 21. — In the subject of the following case, I 
had an opportunity of seeing the sloughing ulcer at 
its commencement. A gentleman w^ho was familiar 
with the venereal disease in his own person, was 
alarmed five days after a suspicious connexion, at 
the appearance of a small pimple on the prepuce, 
which he said he knew to be the commencement 
of a chancre. Being a thinking man, he conceived 
(without knowing that he was supported by the 
authority of John Hunter in what he was about to 
do,) that he might remove the disease entirely, and 
prevent the absorption of the poison by an early, 
excision. He therefore, without farther delay, pinch- 
ed up the part of the prepuce upon which the pim- 
ple was situated, and snipped it off with a pair of 
scissars. The wound healed like a common sore, 
but he observed that the cicatrix was tender, and 
of a deeper colour than the surrounding skin. A 
month after this operation, while the cicatrix was 
still tender, he had connexion with another woman, 
who, he had strong reason to believe, was not dis- 
ordered. Whether he judged rightly or not, — on 
the 8th of August, 1812, the day after this connex- 
ion, an unpleasant sensation induced him to examine 
the penis ; when he perceived near the extremity of 
the prepuce, on the very seat of the former suspi- 
cious appearance, a dark spot, not larger than a 
small pea; this he showed to me the same day, 

2 A 



186 PHAGEDENIC VENEREAL DISEASE. 

when I perceived it was a gangrened spot, without 
any surrounding induration or inflammation. I ad- 
vised him not to take any medicine, until the true 
character of the disease should be fully developed. 

14th. The blackness had increased, attended 
inflammation of the surrounding surface, and a strong 
disposition to phymosis. In consequence of which, 
I advised him to remain at rest, to take some open- 
ing medicine, and apply poultices of bread and 
water to the affected part. Notwithstanding these 
precautions, the swelling and inflammation of the 
prepuce continued to increase; so that on the 17th, 
it was with great difliculty that any part of the glans 
could be denuded. There appeared on the right 
side of the glans, and immediately in contact with 
the ulcer of the prepuce, a black slough, which ex- 
tended as far as could be examined. At the same 
period, the slough on the prepuce had separated, 
and left a phagedenic ulcer. He repeated the open- 
ing medicine, and injected frequently between the 
glans and prepuce a lotion composed of seven ounces 
of decoction of bark, to one ounce of tincture of 
myrrh, which did not excite any pain. 

19th. From the discontent of my patient, that 
mercury was not exhibited, I was in a manner com- 
pelled to allow him to rub in half a drachm of mer- 
curial ointment every night, with a determination 
to stop, as soon as it should appear to disagree with 
him.* He persisted till the 28th, when his mouth 

* It ought to be recollected, that this case occurred in August, 
1812, at a time that I had just commenced the investigaricn. 
Nothing would tempt me now to accede to a patient's entreaties, 
in such a case, to sanction the use of mercury. 



PHAGEDENIC VENEREAL DISEASE. 187 

became slightly affected, and, at the same time, the 
pain, swelling, and inflammation of the penis had 
considerably increased. The prepuce could not be 
retracted, but thin ichorous matter, mixed with par- 
ticles of sloughs, constantly distilled from beneath 
it. The injection, even of warm water, now excit- 
ed intolerable pain, so that it was probable the 
sloughs had all separated, and exposed an irritable 
phagedenic surface. 

He was desired to desist from the further use of 
mercury, and to take thirty drops of antimonialwine 
three times a day, in six ounces of decoction of sar- 
saparilla, and to apply poultices of bread and water 
to the penis. Under this treatment amendment 
soon followed, the swelling and inflammation dimin- 
ished, and the discharge became thicker, and of a 
better quality. 

Matters continued to go on well till the 12th of 
September, but on this day he was chilly and fever- 
ish, and on the following day the fever was consid- 
erable, attended with great lassitude, thirst, and pains 
in the knees, extending down the tibiae. 

14th. There appeared, on a part of the prepuce, 
hitherto unaffected, a small black spot, like the first 
that was observed; and on the 16th, this slough 
separated, leaving a round hole, which passed quite 
through the prepuce, and formed an ulcer, which 
afterwards extended along its internal surface. He 
continued to take the antimonial wine and decoction 
until the 20th, when his uneasiness was so great at 
not using mercury, that to pacify him, I was under 
the necessity of allowing him to rub in a drachm 



188 PHAGEDENIC VENEREAL DISEASE. 

every night. In five nights his mouth was affected, 
and, at the same time, the ulcer, which exhibited the 
true phagedenic character, grew more painful, and 
spread with such rapidity, as to destroy, in two days, 
a considerable portion of the prepuce. At this pe- 
riod he also gave a trial to cinnabar fumigations to 
the ulcer. 

26th. But as it soon became obvious that mer- 
cury, in "every form, was injurious to the ulcer, he 
was at length prevailed on to desist from its farther 
use, and to take in its place, five grains of extract 
of cicuta, three times a day ; which was increased, 
on the 28th, to six grains, four times a day. This 
dose exciting unpleasant sensations in his head, was 
not increased; but it lessened the pain of the ulcer, 
and put a decided stop to its progress. 

Oct. 2nd. I divided a tight band of skin which 
connected two portions of the ulcer together, and 
seemed, by keeping the parts in a state of tension, 
to excite irritation. After this he felt himself con- 
siderably relieved, and passed a better night than 
he had done since the commencement of his com- 
plaint. Next day the ulcer appeared less irritable, 
and on the 5th, the amendment was obvious. On 
the 10th, part of the ulcer had already cicatrized 
without granulations, and in a week afterwards was 
perfectly healed, till which event he continued the 
use of the cicuta. He had however, lost a consid- 
erable, portion both of the glans and prepuce. 

On the 20th of the same month, after enjoying 
the air, and recovering, considerably, his strength, 
he felt uneasiness in the bones of his cheek. On 



PHAGEDENIC VENEREAL DISEASE. 189 

examining it a day or two afterwards, I perceived 
a considerable enlargement of the maxillary bone, 
attended with redness of the integuments, so as to 
threaten a rapid ulcerative process. My patient 
now became greatly alarmed, regretted, notwith- 
standing his former experience of its injurious con- 
sequences, that more mercury had not been used, 
and seemed to wish for a consultation, with which 
I gladly complied. A surgeon of eminence saw the 
patient with me. We agreed upon the plan to be 
pursued, though we had different views of the na- 
ture of the disease. He was of opinion, notwith- 
standing the first appearance and history of the 
complaint, that it was syphilis, modified or altered 
by the peculiarity or morbid state of the patient's 
constitution, and considered the tumour of the max- 
illary bone, to be a true syphilitic node; while, on 
the contrary I was persuaded that the ulcers were 
not syphilitic, as they had not the character or ap- 
pearance of chancres, and did not pursue the same 
progress under the use of mercury. 

The treatment adopted, was the exhibition of one- 
sixth of a grain of muriate of mercury night and 
morning, with a pint of decoction of sarsaparilla 
daily, and the benefit of country air. Two days 
after he had entered upon our plan, the tumour 
began to subside, and in less than eight days was 
totally dissipated. Since this time he has not taken 
any mercury, or had any return of the disease. I 
saw the gentleman after a long interval, and he had 
remained perfectly well. It may be doubted if the 
agency of mercury had any influence in the reduc- 



190 PHAGEDENIC VENEREAL DISEASE. 

tion of the tumour of the maxillary bone, as it began 
to lessen in two days after he commenced its use; 
and in so short a period we can scarcely imagine 
that it could have entered the system, so as to pro- 
duce any sensible effect. 

I shall add one instance more of the sloughing 
ulcer, in order to illustrate the mode by which 
this formidable malady extends itself, by alternate 
sloughing and phagedena, which the reader may 
contrast with the sloughing that is often caused by 
excessive inflammation of the penis, where sores, 
no matter of what description, are neglected and 
irritated. 

Case 21. — Owen Mac Sherry was admitted De- 
cember 21st, 1812, on account of a sloughing ulcer, 
about the extent of a shilling, situated on the inferior 
surface of the penis. He stated, that he was dis- 
ordered three weeks, and that he had rubbed in but 
three drachms of mercurial ointment previous to his 
admission. I directed him merely to confine him- 
self to bed, and to poultice the penis with bread 
and water. 

25th. The slough was cast off, and the ulcer 
assumed the true phagedenic character, and had 
extended considerably. He was directed to take 
the antimonial solution. 

27th. — A slough had again formed over the surface 
of the ulcer. I directed that dossils of lint, moist- 
ened in the lotion of camphorated mixture, and 
tincture of myrrh, should be applied. This, how- 
ever, was of little service. The ulcer continued to 
extend more rapidly than before ; it became more 



PHAGEDENIC VENEREAL DISEASE. 19 1 

painful, and was accompanied by an (Edematous 
swelling of the prepuce. He complained of pains 
in his arms and chest; pulse quick; tongue white, 
with symptomatic fever. The antimonial solution 
was ordered to be continued in nauseating doses, 
and poultices of bread and water were directed in 
place of the lotion. 

Jan. 4th, 1813. — The slough had separated, and 
the sore looked clean and red. It could scarcely 
be said to be phagedenic, but it did not exhibit any 
appearance of granulations. The swelling of the 
prepuce remained unabated, and he complained of 
the severity of the pains in his shoulders and arms. 

16th. — The sore was healing, and the pains in 
his arms were not so severe. On the 29th it was 
completely healed; the pains were entirely remov- 
ed ; and he was discharged the hospital perfectly 
well. 

This description of ulcer, if not checked soon, 
destroys the entire penis, and extending to the scro- 
tum and pubes, engages these parts in one sphace- 
lated mass. Of its destructive tendencies, I have 
given several instances in my former edition, which 
it is unnecessary to repeat here. I am, however, 
happy to observe, that I have not met any of those 
formidable cases since that publication. 

The TREATMENT OF THE SECONDARY SYMPTOMS OF THE 

PHAGEDENIC DISEASE, is conductcd ou the same prin- 
ciple as that already laid down for the constitution- 
al symptoms of the papular and pustular venereal 
diseases, so that little need be added on this part 
of our subject, with the exception of the peculiar 



192 PHAGEDENIC VENEREAL DISEASE. 

modes of treatment which particular symptoms may 
require. 

When the fever, which ushers in the eruption, 
or accompanies it, runs very high, attended with 
severe pains of the head, chest, and joints, general 
blood-letting may be necessary in proportion to the 
quickness of the pulse and severity of the symp- 
toms. Opening medicines and antimonial diapho- 
retics will, at the same time, be most useful auxili- 
aries. If the patient complain of severe pain in the 
head, which is a very common symptom in this, as 
well as the other forms of venereal disease, a blis- 
ter to the nape of the neck, or occiput, may suc- 
ceed in affording immediate relief. During this 
stage of the disorder, confinement of the patient to 
his room, and low diet, with diluting drinks, are as 
necessary as they would be in the treatment of any 
of the exanthemata. 

If the fever be inconsiderable, or if it has been 
reduced, decoction or infusion of sarsaparilla in such 
doses as the stomach can bear, conjoined with anti- 
monials, may be continued until the patient recov- 
ers. 

Guaiacum. which once bore so hisfh a character 
for the cure of venereal diseases as to have received 
the appellation of the Lignum Sanctum, seems to 
have fallen into total disrepute. 

In Astrue*s elaborate work many facts are detailed 
demonstrative of the efficacy of guaiacum-wood. 
He gives the following quotation* from the treatise 

* Book II. p. 146. 



PHAGEDENIC VENEREAL DISEASE. 193 

of Nicholas Poll, physician to the Emperor Charles 
v., published 1536:— 

" That as it were at one and the same time, three 
thousand men, whose lives were quite despaired of, 
were restored to perfect health by the use of the 
decoction of guaiacum; and after their recovery, 
felt as if they were born again." These patients, 
while taking the decoction, which was made as 
strong as possible, w ere confined to bed and to low 
diet. In this way it acted as a powerful diaphoret- 
ic, and was persevered in for thirty or forty days. 

I have made many trials of decoction of guaiacum- 
wood, combined with pills of gum guaiacum and 
antimonial powder, in this form and stage of vene- 
real disease, with considerable effect; but must 
acknowledge, at the same time, that I place much 
more reliance on sarsaparilla. All these medicines 
increase the secretions, and ought not to be exhibit- 
ed in cold weather, unless the patient will confine 
himself within doors. 

If the patient is affected with extensive irritable 
constitutional ulcers with phagedenic edges, great 
advantage may be derived from combining with the 
decoction of the woods, the exhibition of cicuta in 
either powder or extract, in full doses ; so that the 
peculiar effects of this medicine may be sensibly 
felt on the constitution. 

When the cutaneous affection is characterized by 
tubercles, which spread into foul and extensive 
ulcers, such as are delineated in Plate 1. fig. 4, 5, 6, 1 
have reason to believe, that the nitrous acid is parti- 
cularly useful. I have, in many instances, seen these 

2b 



194 PHAGEDENIC VENEREAL DISEASE. 

tumours recede under its use ; but either before or 
after ulceration it will not fail to be found a most 
valuable remedy. 

I am much in the habit, in such instances, of or- 
dering this medicine in combination with decoction 
of sarsaparilla, in tlie proportion of two drachms of 
the diluted acid to a quart of the decoction, of which 
the patient is directed to take as much as will agree 
with his stomach. 

When the patient's nights are disturbed by pains 
of the joints, as well as general restlessness, there 
is no anodyne equal to compound powder of ipeca- 
cuanha, which may be given in such doses as are 
most likely to excite diaphoresis, and procure rest. 

If the pains are severe during the day also, it is 
useful to repeat the powder every sixth or eighth 
hour in conjunction with the sarsaparilla, in place 
of the antimonial solution. Under this simple plan, 
I have succeeded in bringing the most alarming 
cases, in the course of six, eight, or twelve weeks, 
to a favourable termination. But if mercury had 
been unnecessarily exhibited during this period, as 
many months, nay, years, might have been required 
to conquer a malad}' which is chiefly rendered for- 
midable by injudicious interference ; and which too 
often leads the victim of mal-practice through a dis- 
gusting and offensive train of symptoms to a painful 
and lingering death. Half measures will not answer. 
Thus many, in other respects judicious practition- 
ers, adopt the plan of giving mercur}' in alterative 
doses, conjoined with sarsaparilla ; but although this 
is not productive of the same mischief as fuU courses 



PHAGEDENIC VENEREAL DISEASE. 195 

of that medicine, yet I have proof the most positive 
in . numerous instances, that it can serve no other 
purpose but to protract the disease. 

I would not, however, be understood to exclude 
the use of mercury altogether, for the cure of this, 
the most formidable of venereal complaints. It is 
against the abuse, not the use, of this remedy I con- 
tend. For none can be more useful than this, if 
applied at the proper juncture. And that juncture 
is when the disease is on the wane, having in a great 
degree yielded to the powers of the constitution, 
assisted by the remedies already mentioned. This 
stage of the disease will be indicated by the subsi- 
dence of acute fever, the healing of the constitution- 
al ulcers, and the termination of such recent pustu- 
lar or tubercular spots as occur, into a kind oi scabby 
desquamation, instead of spreading into ulcers cover- 
ed with thick crusts, like their precursors. Mercury 
wdli not then interrupt the natural progress of the 
disease, but rather hasten it to its termination with 
well-timed assistance, while the chance is reduced 
to little or nothing, of exciting any venereal affection 
in the deep seated parts. Instead, therefore, of in- 
juring the patient's constitution,, perhaps irretrieva- 
bly, by premature and repeated courses of this 
medicine, the advantage is inappreciable of with- 
holding its application till the season arrives when 
it may be administered with a well-founded prospect 
of success. 

And here I beg to subjoin a practical observation, 
sufficiently plain and obvious to be easily compre- 
hended by the most careless practitioner, or by 



196 PHAGEDENIC VENEREAL DISEASE. 

those who are averse to troublesome distinctions, 
but are pleased with well marked outlines. To 
such it must be satisfactory to know, that for scaly 
eruptions, (no matter whether their scaliness has 
appeared in the very commencement, as in syphilis, 
or towai-ds their termination, as in other venereal 
complaints, when the eruption and the disease are 
equally on the wane, and yielding to the powers of 
the constitution,) mercury may be exhibited with 
every prospect of advantage, or at least with little 
danger of inflicting the injury which is seen to oc- 
cur if the spots, at the time, are destitute of the 
scaly appearance. 

If the disease is then evidently on the decline, 
but chronic and lingering, and it should be deter- 
mined to give mercury, it may be inquired, what is 
the most appropriate form of this medicine in such 
cases ? I am inclined to regard the question as not 
veryimportant, provided the preparation is sufficient 
to excite the mercurial action in the system. When 
the skin or throat is affected, I usually prescribe the 
solution of the muriate of mercury, or the compound 
calomel pill, in conjunction with decoction of sarsa- 
parilla, on account of their tendency to affect the 
skin. If the patient is particularly delicate, I direct 
the decoction and five grains of blue pill every night. 
But if he is attacked with nodes of the bones, or af- 
fections of other deep seated parts, when it may be 
necessar}^ to excite a full mercurial action, for the 
purpose of influencing their low organization, mer- 
curial frictions are often preferable, as they are not 
so likely to irritate the stomach or bowels as the 
internal use of mercurv. 



PHAGEDENIC VENEREAL DISEASE. 19'7 

The formidable ulcerations of the throat which 
attend this disease, have already been described, 
and require the adoption of the most prompt and 
decisive measures, lest the patient should suffer the 
loss of parts which might either endanger his life, 
or render it a burthen to him ever afterwards. 

If the ulceration is of small extent, representing 
a white aphthous looking surface, any of the follow- 
ing local applications may be employed every third 
or fourth hour, by means of lint on the end of a 
probe, or a large camel's hair pencil, viz. oxymel 
aeruginis, or a solution of the nitrate of silver in the 
proportion of from six to ten grains to an ounce of 
distilled water, or a solution of the oxy-muriate of 
mercury in the proportion of from three to six grains 
to an ounce of distilled water. 

But if the ulceration is extensive, engaging the 
entire fauces as far as can be inspected, and having, 
perhaps, already destroyed the uvula, and a great 
portion of the velum, recourse should immediately 
be had to fumigations of the red sulphuret of mer- 
cury (factitious cinnabar) employed every fourth or 
sixth hour ; or if the patient cannot bear the fumes 
of this preparation, fumigations of the hydrargyrus 
cum creta may answer equally well. It will be ob- 
jected to me that the adoption of these means is in 
direct opposition to the preceding doctrine, that 
mercury ought not to be employed until the disease 
is on the wane ; whereas, it is here recommended 
in a way which often mercurially affects the con- 
stitution while the poison is in its state of highest 
activity. This is undoubtedly true, but my answer 



198 PHAGEDENIC VENEREAL DISEASE. 

is simply, that it is always better of two evils to 
choose the least ; and therefore, that it is more pru- 
dent to adopt the use of a remedy capable of check- 
ing a dangerous ulceration, even though that remedy, 
by exciting general mercurial action, may render 
the disease, of which the ulcer of the throat is but a 
symptom, more unmanageable, than to permit a 
malignant ulcer to proceed in destroying parts of 
undoubted importance, and which, perhaps, involve 
life itself in their destruction. 

Fumigations of sulphuret of mercury may, how- 
ever, only act locally on the sore without mercurially 
affecting the constitution, and I make it a rule, as 
soon as I percieve any amendment in the state of 
the ulcer, to discontinue them, in order to prevent, 
as far as is consistent with the use of their application, 
the constitution from becoming mercurially affected; 
and thus we may receive all the benefits, and escape 
the dangers, which the remedy is capable of effect- 
ing- 

So great is the utility of those applications, that 

in the numerous cases of extensive ulceration of the 
pharynx which have come under my observation, I 
do not recollect one which did not yield to their 
influence, unless the ulcer had extended upwards 
into the nares or downwards into the larynx. When 
either of these misfortunes has occurred to the pa- 
tient, his situation is truly critical; for parts have 
now become affected w^hich, from their structure and 
functions, are not easily remedied; and it requires 
great prudence and circumspection in the practition- 
er to decide upon the means to be employed, and 



PHAGEDENIC VENEREAL DISEASE. 199 

tcliich may be pursued with steadiness ; as nothing 
is more frequently injurious than vacilation. 

If we were certain that the mercurial irritation on 
the system would cure ulcers in these situations, I 
should not hesitate a moment in having recourse to 
mercury, no matter how injurious its effects might 
be to the general disease; but unfortunately all the 
evidence was the other way. In most instances, 
however, the exhibition of mercury checks those 
ulcers; and they amend for a time, but return 
again and again after the mercurial irritation has 
subsided ; or after the constitution has become re- 
conciled to its presence, until in the one instance, 
the bones of the nose become extensively diseased, 
with consequent deformity ; or in the other, until 
the cartilages of the larynx and its coverings are 
so ulcerated, thickened, and diseased, that the 
function of respiration becomes impeded, and a train 
of most distressing symptoms ensue, that are soon 
followed by the well known indications of the pre- 
sence of phthisis pulmonalis, which at length re- 
leases the patient from all his sufferings. Between 
this choice of difficulties, it would be presumptuous 
to attempt to lay down with precision any certain 
line of treatment, which ought to be pursued in 
every instance. 

I shall, therefore, merely state the line which I 
very generally take, with my reasons for its adop- 
tion ; and at the same time suggest one measure 
for the treatment of this disease of the larynx, which 
I believe has not been practised. 

Ulceration of the nares, either caused bv the ex- 



200 PHAGEDENIC VENEREAL DISEASE. 

tension of an ulcer from the fauces, or from its oc- 
currence there in the first instance, is indicated by 
difficulty of breathing through the nose; the voice 
is observed to be nasal, and these symptoms are 
soon followed by discharges of crusts, followed by 
matter of an offensive kind, occasionally mixed with 
blood. Where these symptoms exist, the surgeon 
is, on examination, in general, able to detect the pre- 
sence of ulceration, either on the turbinated bones, 
the septum nasi, or on both, accompanied by an in- 
flamed and thickened state of the pituitary mem- 
brane. 

The general practice is to have recourse imme- 
diately to the internal use of mercury; but for the 
reasons just mentioned, I prefer, in the first instance, 
nearly the same external applications of this reme- 
dy which were recommended for ulceration of the 
throat, but modified to meet the dijSference of struc- 
ture and situation of the parts engaged. With 
these views, the affected nostril may be well anoint- 
ed morning and evening with a liniment or soft 
ointment, composed of one part of the nitrated mer- 
curial ointment to three of olive oil ; this may be 
done by means of a large camel's hair pencil, long 
enough to admit of its being introduced to a suffi- 
cient depth. 

The nares may also be injected frequently dur- 
ing the day with the weak yellow mercurial wash, 
made in the proportion of half a grain of oxy-muriate 
of mercury to an ounce of lime-water. 

If these means, after a sufficient trial, conjoined 
with the internal exhibition of sarsaparilla, do not 



PHAGEDENIC VENEREAL DISEASE. 201 

appear to succeed, let the fumigations of factitious 
cinnabar, or of hydrargyrus cum creta, be employ- 
ed three or four times a day, in place of the yellow 
wash, by means of a bent tude adapted to the size 
of the nostril, and fitted to the common apparatus 
for fumigating the throat. 

Under these plans I have succeeded in numerous 
instances in curing this formidable affection, with- 
out the internal exhibition of a grain of mercury. 
If, however, the ulceration should appear not to 
heal, or if it should return more than once, after 
liaving been healed, we may then feel authorized, 
in addition to the external application recommend- 
ed, to give mercury internally. 

The preparations I employ in such cases, are 
either the solution of the oxy-muriate of mercury, 
or the compound calomel pill of the London Phar- 
macopoeia, conjoined with the exhibition of sarsa- 
parilla. A restricted trial of either of these prepa- 
rations, during four, five, or six weeks will suffice, 
without extending their use, so as to excite saliva- 
tion. If the bones become affected, they must ex- 
foliate before the parts can possibly heal ; and on 
account of the readiness with which the spongy 
bones of the nose become extensively diseased, this 
must necessarily be a tedious as well as a disgust- 
ing process. But surely it is unnecessary to add to 
the patient's sufferings, by keeping him month after 
month under the influence of mercury, first of one 
formula and then of another, until the unfortunate 
victim has run the gauntlet through the entire bat- 
talion of mercurial preparations, with the view of 

2r 



202 PHAGEDENIC VENEREAL DISEASE. 

assisting him in a process, which is best accomplish- 
ed by supporting instead of diminishing the powers 
of his constitution. 

Unfortunate wretches daily present themselves at 
the Hospital for advice, with the septum and tur- 
binated bones destroyed, so that the nares exhibit 
one large cavity, the walls of which are a foul ul- 
cerated surface. A patient thus affected ought to 
be sent to the country, where he should live chiefly 
on a milk and vegetable diet; he ought also to be 
particular in keeping his apartment well venti- 
lated ; for the air he breathes passing over an ex- 
tensive ulcerated surface, is rapidly vitiated, and 
must be injurious if breathed a second time. In 
this situation, calculated to improve his general 
health, he can employ with best advantage the 
means already recommended. 

The extension of an ulcer in the throat to the 
larynx is first indicated by hoarseness, and a slight 
degree of that peculiar croupy cough, evincing to 
an ear which has once heard it that the larynx is 
the seat of the disease. The countenance of the pa- 
tient soon betrays an expression of restless anxiety, 
occasioned by the perpetual efforts to cough up the 
thick viscid phlegm or discharge, w4th w^hich the 
larynx becomes choaked. His pulse, at first quiet, 
afterwards becomes rapid; the cough, more incessant, 
is decidedly croupy, night sweats soon set in, fol- 
lowed by emaciation, and all the other concomitants 
of phthisis pulmonalis. 

Whether the larynx is ever the first part of the 
throat attacked by ulceration, I shall not take upon 



PHAGEDENIC VENEREAL DISEASE. 203 

me to determine. In most of the instances which 
came under my observation, the ulcer commenced 
in the pharynx, and becoming chronic, healed above, 
while it was at the same time deceitfully extending 
in an opposite direction; and in this way, I have 
reason to believe, the epiglottis first, and afterwards 
the larynx, usually become affected. 

When it attacks this situation, direct applications 
are out of the question ; fumigations or strong solu- 
tions of nitrate of silver may possibly reach the epi- 
glottis, but the disease, when it arrives at this point, 
seldom fails to extend farther. Our only resource 
then, in order to check with as little delay as possi- 
ble the ulceration and consequent thickening of the 
larynx, will consist in counter-stimulants applied to 
the skin, and the internal exhibition of mercury. 
Blisters applied over the larynx are the more ob- 
vious counter-stimulants ; but I have used them so 
often without observing any benefit to follow their 
application, that I am convinced they only serve to 
add to the torment of the patient. Caustic issues 
over the thyroid cartilage have afforded, in the 
trials I have made, some little relief; and in one in- 
stance I flattered myself that the application of 
moxa in the same situation, conjoined with the in- 
ternal exhibition of mercury, had cured the disease, 
as a patient labouring under all the symptoms of 
ulceration of the larynx, apparently recovered under 
these means ; three months, however, after his dis- 
charge from the Hospital, he returned extremely 
ill, and died on the following day. These parts en- 
gaged, which are preserved, were examined, and it 



204 PHAGEDENIC VENEREAL DISEASE. 

was found that a large quantity of serous fluid was 
effused underneath the mucous membrane of the 
upper opening of the larynx, so as forcibly to raise 
or detach the membranes from the epiglottis and 
arytenoid cartilages. The aryteno-epiglottidean 
folds were swollen and oedematous, the epiglottis 
so thickened and rigid as scarcely to be susceptible 
of the slightest elevation or depression. A foul 
ulcer, the size of a shilling, was situated on the inner 
surface of the trachea, immediately below the cricoid 
cartilage, and the larynx and trachea were filled 
with viscid mucus. 

The exhibition of mercury, conjoined with coun- 
ter-stimulants, is at first in general attended with 
advantage, and the patient may even recover so far 
as to think himself well ; but exposure to the open 
aij* too often brings back the symptoms more se- 
verely than before. The preparations of mercury, 
upon which I place most reliance in these cases, are 
the same I employ for ulceration of the nose, viz. 
the oxy-muriate of mercury, calomel conjoined with 
opium, or the compound calomel pill. 

If the disease does not yield to a rational trial of 
these means, still we are not under the necessity of 
abandoning the patient to his fate. There is one 
measure still in reserve — the operation of tracheot- 
omy ; but in order to afford this expedient a chance 
of success, it ought to be tried before those symp- 
toms arise which indicate an affection of the lungs; 
and should be performed in such a manner as will 
not only admit the patient to breathe freely through 
the artificial opening, but allow an easy passage for 



PHAGEDENIC VENEREAL DISEASE. 205 

the discharge of mucous, otherwise the opening be- 
coming obstructed, will not fulfil the intended ob- 
ject. For the same reason, a tube introduced into 
the opening, from the necessarily small size of its 
aperture, is altogether useless. The only mode in 
which tliis operation can be attended with advan- 
tage, is by the removal of a portion of the rings 
of the trachea, either by the knife or scissars, as I 
have often practised in cases of croup.* I must 
acknowledge that I have not give» the operation a 
trial in that state of the larynx under consideration ; 
but from its beneficial effects in acute disease of 
that organ, I am decidedly of opinion that there are 
quite sufficient grounds to authorize its adoption, 
in affections of a more chronic but equally fatal 
description ; and I have been on several occasions 
prevented from proceeding to this measure, by the 
symptoms of a diseased state of the lungs becoming 
so rapidly apparent as to evince that nothing could 
save the patient's life. 

The presumed modus operandi of an opening in 
the trachea^ as a remedy, is to allow the patient to 
breathe through the artificial opening, and permit 
the larynx to remain undisturbed by the presence 
of a constant current of air, and thus induce that 
favourable state of quiescence, which is necessary 
to the healing of an ulcer in any situation. 

The only remaining symptoms of the phagedenic 
disease, the treatment of which we have to consider 
are, pains of the joints, and nodes of the bones ; but 

* See Vol. 11. and IV. of the Transactions of the Association of 
the King and Queen's College of Physicians, Dublin- 



206 FHAGEDENIC VENEREAL DISEASE. 

little need be said on this subject, as it would only 
be a repetition of what was recommended for simi- 
lar symptoms occurring in the pustular venereal 
disease. It may, however, be useful to remark, that 
the affection which is particularly frequent and se- 
vere in the phagedenic disease, is inflammation and 
swelh'ng of the knee joint, which require the most 
active antiphlogistic plan; such as frequent local 
depletions, either by means of leeches or the scari- 
ficator. 

Warm fomentations, and poultices of bread and 
water, are also of service ; and when the activity of 
the inllam.mation is reduced, the application of blis- 
ters, or of the tartarized antimonial ointment, is of 
great service. I have seen many instances of venereal 
inflammation of the knee joint, where these means 
had been neglected, and mercury imprudently pre- 
scribed and obstinately continued, which, as might 
be expected, terminated fatally. Three af these 
cases I happened to see in private practice ; in one, 
the patient, after great sufferings from suppuration 
of the joint, underwent amputation, but shortly af- 
terwards died consumptive. In the other two cases 
the patients endured the protracted suffering and 
hectic fever which arises from the change of struc- 
ture, induced by inflammation of the synovial mem- 
brane. Mercury was employed to the usual extent. 
Death, however, was the consequence. But in nu- 
merous instances, this symptom was treated in the 
manner above recommended, to which it yielded 
in the most satisfactorj^ manner, without the exhi- 
bition of a single grain of mercury. 



PHAGEDENIC VENEREAL DISEASE. 207 

When the other joints, particularly the wrist, or 
ankle, are severely affected, local blood-letting may 
also be necessary ; but generally speaking, there is 
no application equal to the tartarized antimonial 
ointment for the removal of chronic venereal pains. 
While at the same time, the general or constitution- 
al treatment already detailed, in conjunction with 
the use of the >varm bath, should not be neglected. 

When nodes occur, (and I am not certain that 
they ever do in this species of venereal disease 
when mercury has not been employed) leeches, fol- 
lowed by a repetition of blisters to the part, will 
generally relieve the pain, and diminish those swell- 
ings. But if, notwithstanding these means, the 
nodes should continue obstinate, and the pains se- 
vere, recourse must be had to mercury, although it 
was originally, perhaps, the very cause of those 
nodes : not indeed by producing a mercurial disor- 
der, but by driving the venereal disease from the 
surface to the interior. These affections of the 
bones, it is to be hoped, will in time become more 
and more rare, according as the inveterate practice 
by which they are occasioned, gives place to the 
modern improvements so obviously necessary. — 
Periostitis, no matter from what cause it may origi- 
nate, is powerfully combated by the mercurial irri- 
tation, which acts by checking the adhesive inflam- 
mation. The preparation I prefer, is calomel com- 
bined with opium, given to such an extent as to af- 
fect the gums ; but if the stomach or bowels are 
delicate, mercurial frictions must be employed. If 
all these means fail, our only resource lies in a free 



208 PHAGEDENIC VENEREA!^ DISEASE. 

division of the inflamed periosteum covering the 
node, which seldom fails to afford relief. 
' Enlargement of the testes is also a frequent symp- 
tom of this form of the disease, but I do not recol- 
lect to have seen it in any case where mercury had 
not been previously employed. I always treat it 
on the same general principles applicable to nodes, 
— viz. leeches, counter stimulants, antimony, and 
sarsaparilla. If these fail, then calomel combined 
with opium or cicuta will be necessary, in altera- 
tive doses. 

In fact, the treatment recommended for this, as 
well as every other form of venereal disease, is 
founded upon general pathological principles, and 
the success which has attended these views, suffi- 
ciently proves that venereal complaints are neither 
©bscure or incomprehensible ; but that they yield 
to that treatment which a plain sound pathology 
points out, and which is available against the other 
diseases to which they bear an analogy. 

Notwithstanding the length of time which has 
elapsed since the ill effects of mercurial courses in 
the phagedenic form of venereal disease was first 
urged upon the public, and although the inordinate 
use of mercury has considerably diminished since 
that period, I regret that I am in this edition oblig- 
ed to repeat the observation, that there is scarcely 
a day in which I do not see some fresh instance of 
a constitution broken down b}^ reiterated and pro- 
tracted courses of this mineral, for this species of 
venereal disease ; yet the faith of the practitioner is 
still undiminished in his specific : and the patient 



PHAGEDENIC VENEREAL DISEASE. 209 

is, year after year, assailed by some new symptom, 
for which he is again to submit to a remedy more 
destructive than the disorder. 

The phagedenic and sloughing ulcers, probably 
present the most unfavourable form of venereal dis- 
eases, the most uncertain in their progress, and the 
most fatal in their result ; but they have been ren- 
dered still more destructive by the manner in which 
they have been hitherto treated. The constitution- 
al disease which they produce, may be retarded, or 
suspended, but cannot be superseded altogether 
by the mercurial action on the system. It may 
yield to the powers of the constitution, but will not 
to mercury, which in this complaint deserves the 
character of a ready and valuable instrument in our 
hands, well calculated, under peculiar circumstances, 
to check the progress of a dangerous ulcer, or to 
alleviate the severity of the pains of this species of 
venereal disease. One of the great errors in prac- 
tice, arises from an inference that all ulcers or 
pains which are relieved by mercury, must there- 
fore be syphilitic; and consequently that a full 
course of mercury is required for their cure. If we 
esteemed mercury merely as an instrument, by 
which we have it in our power to raise an action 
artificially in the system, capable of superseding 
that of some poisons, but only of suspending that 
of others, we should avoid a source of inextricable 
error, and might then more usefully direct our at- 
tention to discriminate those which may be super- 
seded or cured, from those which can merely be 
suspended or alleviated by its influence. 

2d 



^1<^ PHAGi;DENIC VENEREAL DISEASE. 

lii: relinquishing the hope of curing this disease!, 
lijte syphilis, by a full mercurial action, and of leav- 
ing it in a great measure to the powers of the con- 
stitution, we certainly resign the too often disap- 
pointed expectation of the eclat which the rapid 
recovery of our patient might produce; but we 
shall probably have the satisfaction, in the end, of 
guiding him through a most difficult and perplexing 
i^alady, and of escaping the mortification of seeing 
his complaints rendered more inveterate by our 
efforts, to remove them, and of the unpleasant feel- 
ings that must result when we are conscious that 
those very efforts have tended more to subvert his 
constitution, than the poison which they were in- 
tended to subdue. 

I shall now proceed to give a few cases of the con- 
stitutional symptoms of the phagedenic disease, many 
of which also afford instances of the existence, on 
the same individual, of the primary symptoms. I 
shall, in the first instance, detail those cases which 
exjemplifyihe injurious consequences attendant upon 
the too early exhibition of mercury, and the train of 
difficulties, embarrassments, and disappointments, 
wliich the practitioner entails upon himself by con- 
tinuing this line of practice. And these cases may 
be considered as the stepping stones by which 1 
advanced to that mode of treatment, w^hich has an- 
swered my most sanguine expectations. I shall af- 
terwards subjoin cases that may be contrasted with 
the former, which were treated, from the time they 
came; under my care, according to the views I have 
above unfolded. 



PHAGEDENIC VENEREAL DISEASE. 2^11 

It was not at first my intention to burthen this 
work with the detail of any cases, but I am inclined 
to believe, that my views of the phagedenic disease 
would be very imperfectly understood, without the 
minute and faithful details which these records pre- 
sent to the mind. 

Cases exemplifying the injurious consequences at- 
tendaiit upon the early exhibition of mercury for 
the constitutional symptoms of the phagedenic dis- 
ease ; but many of them also illustrating the bene- 
Jicial effects of that medicine ivhen the disease is 
on the wane. 

Case 22. — Martha Lloyd was admitted Septem- 
ber 10th, 1813, on account of a discharge of an acrid 
excoriating matter from the vagina, but from the 
swelling and excoriation of the parts, it was impos- 
sible to ascertain the nature of the surface from 
which it proceeded. There were pustules scattered 
over her body, but more numerous on her back than 
on any other part, which were of a large size, and 
as distinct as those which occur in a case of mild 
small-pox. There was also an ulcer on the outside 
of the left leg, extending from the ankle upwards, 
a^ large as the palm of the hand, and of a black 
sloughy appearance. A white superficial ulcer was 
situated on each tonsil, and she was affected with 
ptyalism, although, as she asserted, she had not used 
any mercury. She also complained of pains in her 
shoulders, and her strength and constitution seemed 
to be greatly reduced. 



212 PHAGEDENIC VENlTREAL DISEASE. 

She stated, that she was affected with the dis- 
charge and soreness of the pudenda, three months 
before her admission, and that about the middle of 
that period, the constitutional symptoms had begun 
to appear. I directed her to take the antimonial 
solution and decoction of sarsaparilla. The symp- 
toms were not, however, in the smallest degree 
checked by these medicines ; the pustules became 
more numerous : those that at first appeared, had 
become dark brown crusts, concealing ulcers, the 
largest of which, formed on the sacrum, and was, at 
least, six inches in circumference. The ulcer of 
her leg also increased, and the ulcers of the tonsils 
extended to the back of the pharynx, and engaged 
the velum and uvula in their progress. On the 21st 
of September, a drawing was taken of the appear- 
ance of the eruption and ulcers on her back. (Plate 
III. fig. 1 and 2.) I did not any longer delay the 
exhibition of mercury, but directed that she should 
take a pill, containing one grain of calomel and half 
a grain of opium, three times a day. 

28th. The greater number of the pustules had 
changed their appearance into dark-brown conical 
crusts, which were, in general, at their bases, about 
the size of a sixpence. The ulcer of her leg look- 
ed somewhat better, as did also those of her throat. 

Oct. 12th. She was evidently affected by the 
mercury, and her swallowing was easier, but I could 
not examine the state of her throat, as from the 
number and extent of the ulcers on her back, she 
was obliged to lie upon her face. The crusts on 
the smaller ulcers closely resembled, in appearance, 



PHAGEDENIC VENEREAL DL-EASE. '2115 

the common limpet shell. No fresh pustules had 
appeared, and many of those on her limbs had form- 
ed crusts, which, falling off, left the parts underneath 
cicatrized; an evident indication, that the disorder 
was giving way to the means employed. She was, 
however, greatly reduced, and her legs became 
(Edematous. These circumstances induced me to 
discontinue the mercury, and the rather, as the pro- 
gress of the disease was decidedly checked. She 
was now ordered bark and wine, which, however, 
with every attention to diet, were insufficient to 
support her declining strength, although such ulcers 
as were exposed by the falling off of the crusts, 
exhibited a granulating appearance. The great 
extent of ulcerated surface so harassed a debilitated, 
broken down constitution, that she did not survive 
longer than the 2d of November following. 

If this patient had continued on the use of sarsa- 
parilia, which might have been advantageously 
combined with opium or cicuta, in doses sufficient 
to mitigate the state of irritation caused by extensive 
and painful ulcers ; and if mercury had not been 
employed, I have little doubt, from my present ex- 
perience, that she would have recovered. 

Case 23. — The eruption of the phagedenic dis- 
ease, in its scabbing stage, frequently forms conical 
crusts resembling the limpet shell in appearance. 
(See Plate III. fig. 2. and Plate IV.) I have, how- 
ever, met with a few instances, in which one or two 
of the crusts rose into projecting hard cones, re- 
sembling horns. 

My attention was called to a remarkable instance 



214 PHAGEDENIC VENEREAL DISEASE. 

of this description, on the 26th of October, 1813, 
by one of the surgeons of the hospital, under whose 
care the patient, Patrick Kenny, was placed. He 
had three spots at that time on his face, formed by 
large brown conical crusts, one of which, in par- 
ticular, projected like a horn from his forehead, and 
is delineated in Plate III. fig. 3. He complained of 
pains in his shoulders, elbows, knees, and ankles, 
which last were red and swelled. On examining 
the penis, I discovered the cicatrix of a deep ulcer 
which had excavated the corona and superior surface 
of the glans penis. 

I learned that this ulcer had made its appearance 
in October, 1812; and that it healed with difficulty 
towards the conclusion of a severe course of mer- 
cury of two months' continuance, during which 
period he had taken pills and rubbed in six ounces 
of ointment. He had, however, scarcely finished 
the course, when a frill of soft warts, or fungi, sub- 
ject to frequent bleeding, sprouted up round the 
corona glandis. For this complaint he was again 
put upon a mercurial course of several months, 
during which he took pills night and morning, and 
rubbed in eleven ounces of ointment. 

On the 10th of March, 1813, he was seen by an 
intelligent pupil of the Hospital, Mr. Adams,^ who 
has attended my lectures on these diseases, and seen 
my practice in the Hospital, who favoured me with 
the following history of his complaints from the time 
he first saw him, until he came under my observa- 
tion. 

* Now a member of the College of Surgeons, and Lecturer on 
Anatomy and Surgery. 



PHAGEDENIC VENEREAL DISEASE. 215 

He found the patient labouring under severe 
ptyalism, and at the same time affected with exces- 
sive inflammation of the penis, owing in a great 
measure to some corrosive application which had 
been applied to the fungi. He directed him to dis- 
continue the mercury, took blood from his arm, con- 
fined him to low diet, and ordered him antimonials. 
In a few weeks, under these means, the inflamma- 
tion was reduced, the fungi disappeared, and the 
patient considering himself well, returned to Jiis 
business. 

But on the 23d of May following, he was again 
taken into the Lock Hospital, on account of pains in 
his arms, and an ulcer which had formed on the 
back of the pharynx. 

. For these complaints he was again submitted to 
another full course of mercury, under which the 
ulcer of his throat healed ; but while he was affected 
with ptyalism, even to a quart daily, he was attacked 
with severe pains in all his joints, and his wrists 
and knuckles became red and swelled. At the same 
time an eruption of pustules, which formed ulcers 
covered with crusts, appeared in different parts of 
his body. In consequence of the appearance of 
these symptoms in the midst of a course of mercury, 
that medicine was properly discontinued, the pains 
were considered to be rheumatic ; and he was ad- 
vised to leave the hospital for the benefit of pure 
air, and for the purpose of recruiting his shattered 
constitution. 

But in the beginning of the September following, 
he was admitted for the third time into the hospital. 



216 PHAGEDENIC VENEREAL DISEASE. 

for the symptoms described in the beginning of his 
case. 

From the 26th of October already mentioned, 
though he was not under my immediate care, I saw 
him daily. The medicines he took were decoction 
of sarsaparilla and solution of muriate of mercury, 
under which he perfectly recovered from his pains, 
and the conical crusts already described fell off, 
leaving the surface underneath perfectly healed. 
On the 24th of December, he was discharged the 
hospital w^ell. He was desired to return if any re- 
lapse should occur, but he has not since returned. 

I need scarcely observe, that if a similar case were 
now to come under my care, I should treat it with 
sarsaparilla and antimonials^ and not give a grain of 
mercury. 

Cas& 24. — Thomas Dunn, admitted Sept. 3d, 
1814. An extensive phagedenic ulcer of the glans 
penis formed a deep cleft that almost divided it into 
two parts ; there was also an ulcer on his forehead 
covered with a thick crust, and a similar one on his 
side. He had been using mercury three weeks pre- 
vious to his admission, under which the ulcer had 
extended. At this period, circumstances which I 
then misunderstood, but which I have since been 
able to unravel, and which I shall have occasion to 
advert to, induced me to think that the phagedenic 
primary ulcer would be benefited by the use of 
mercury, if the patient was at the same time affect- 
ed by constitutional symptoms. Under the influence 
of this opinion, which I have long since relinquish- 
ed, I determined to give a trial to mercury in this 



PHAGEDENIC VENEREAL DISEASE. 217 

and two or three other cases, and accordingly I or- 
dered the muriate of mercury, conjoined with the 
decoction of sarsaparilla, for the patient soon after 
his admission. Under this plan the symptoms im- 
proved for a time, but they soon began to relapse 
to their former state, with the accession of new 
ones, as observable in all similar cases, unless the 
exhibition of mercury is postponed till the disease 
has nearly exhausted itself. 

In the present instance, about a month after the 
patient had entered upon the use of mercury, and 
while his gums were affected, he was attacked with 
severe pains in his different joints^ but particularly 
in one knee ; and a great number of pustular spots, 
which soon formed crusts, and ulcers appeared on 
different parts : — at the same time the old ulcers 
extended with a phagedenic edge. 

In December they were at their utmost extent, 
several the size of a dollar; one on his neck was as 
large as the palm of the hand. There were also very 
extensive ulcers on both thighs. 

According as these ulcers began to mend they 
healed from their centre, and frequently, while heal- 
ing in the centre, were extending with a phagede- 
liic margin at their circumference. At length, un- 
der the use of the muriate of mercury, blue pill, 
calomel with antimony, cicuta and sarsaparilla, the 
ulcers healed before the 4th of March, and he was 
discharged the hospital. 

He was, however, re-admitted on the 17th of the 
following April, on account of an extensive ulcer of 
phagedenic appearance, which engaged the left 

2e 



218 PHAGEDENIC VENEREAL DISEASE. 

tonsil and the entire velum, a great part of which it 
had destroyed. This ulcer it was necessary to 
check as rapidly as possible, and, therefore, re- 
€Oiirse was had to mercurial frictions, and the solu- 
tions of the muriate of mercury.^ Under this 
course the ulcer rapidly amended, and he was dis- 
charged the hospital well on the 28th of May, since 
which time I have not seen him. 

Many will argue, that if mercurial frictions had 
been resorted to at the commencement, instead of 
the other preparations of mercury, the disease 
would have been subdued at an early period ; and 
if I myself were to draw my conclusions from this 
case alone, I should be of the same opinion ; but I 
have met with so many similar cases in which the 
effects of full, or even the gentlest mercurial action 
on the system was highly injurious at the com- 
mencement of the constitutional disease, that I have 
not the slightest doubt of the inutility and danger 
of its adoption until the disorder is on the wane. 

Case 25. — Mary Fitzgerald, setat. 25, admitted 
Feb. 25th, 1815, on account of a small ulcer of foul 
appearance and phagedenic character on one of the 
labia, and an eruption of pustules on her face and 
body. She also complained of pain in her right 
arm. She stated that she was but four weeks dis- 
ordered previous to her admission, and that she had 
not used mercury. Decoct. Sarsap. — Solut. Antim. 
— Lot. Hydrarg. Flava. 

As no amendment was apparent under this plan, 

* If a similar case were now to come under my care, I should 
content myself by ordering fumigations of the red sulphuret ot 
mercury to the throat, and decoction of sarsaparilla. 



PHAGEDENIC VENEREAL DISEASE. 219 

on the 3d of March she was directed to take a 
grain of calomel night and morning, which on the 
20th had affected her mouth severely. At this 
time the eruption had assumed the form of ulcers 
covered with conical crusts, and a white apthous 
ulcer had appeared on the velum and uvula. The 
mercurial pills were discontinued, and she was or- 
dered two grains of opium at night to allay the irri- 
tation arising from her complaints, particularly the 
soreness of her mouth. 

April 10th. — The ulcers had extended, and on 
her face presented the appearances depicted in 
Plate IV., which was engraved from a drawing 
taken this day, and exhibits a most accurate re- 
presentation of this form and stage of the disease. 
There were four or five similar spots on her neck 
and back; one of them had thrown off the crust 
and exposed a pale unhealthy ash-coloured surface. 

17th. — All the spots had so far extended, that her 
lip and nose were nearly covered by the crust 
which had formed on those parts. The ulcer of 
her throat had also spread in so great a degree as 
to engage the velum, right tonsil, and back of the 
pharynx, in one extended white slimy ulceration. 
Every attempt to swallow was attended with re- 
gurgitation through the nose. From constant irri- 
tation and want of nourishment she was greatly re- 
duced. The ptyalism continued to three pints a 
day; but conceiving that this was in a great mea- 
sure owing to the irritation of the ulcer in her 
throat, I directed the frequent use of cinnabar fu- 
migations, and such nourishment as she was capa- 



220 PHAGEDENIC VENEREAL DISEAsiE. 

ble of swallowing. She sunk rapidly, and died on 
the 23d of April. 

This case closely resembled in its symptoms that 
of Martha Lloyd, the first detailed of this series of 
cases. And the observations which I had occasion 
to make respecting the mode of treatment I should 
now adopt for the symptoms with which that pa- 
tient was affected, apply with equal force to the 
present instance. 

Case 26. — James Heney, admitted Sept. 27th, 
1815. An ulcer about the size of a sixpence, exhi- 
biting a white sloughy appearance, was situated on 
thje body of the penis, the integuments of which, 
were undermined to som-e little extent. There was 
also an ulcer situated on the upper lip, covered by 
a large conical scab. He had been about two 
months affected, and had rubbed in two ounces of 
ointment, and taken 20 pills, which affected his 
mouth, but did not produce any beneficial change 
in his complaints ; on the contrary, the ulcer on his 
lip occurred, as he stated, while he was under the 
infliience of mercury. — Decoct. Sarsap. — Solut. An- 
tim. 

On the 15th of October, the crust separated from 
the spot on his lip, exposing an ulcer covered with 
white tenacious matter. The ulcer on the penis 
was healing at one end, w^hile it w^as extending at 
the other (that next the pubes,) by burrowing un- 
der the skin. 

29th. — He complained of severe pain in his knee. 
After hot fomentations had been used for some 
days, the ointment of tartarized antimony was rub- 



PHAGEDENIC VENEREAL DISEASE. 221 

bed on his knee, and produced a large crop of pus- 
tules, which evidently relieved the pain. 

In the beginning of November he was put upon 
the use of nitrous acid, and about the middle of 
the month the ulcer of the penis and that of his lip 
were nearly healed. In the beginning of Decem- 
ber, his amendment seemed to cease, and some new 
symptoms appeared, viz. raised spots on his fore- 
head and at the root of his nose, of a copper-colour 
and firm consistence. It was difficult to say whether 
they presented a scaly or a scabby appearance, but 
they did not, like the preceding spots with which 
he was affected, show any disposition to ulcerate. 
These symptoms, such as I have described them, 
always convey to me at present an indication that 
the disease is on the decline; and that mercury may 
be used not only with safety, but effect : but when 
this case was under my care I had not arrived at 
this point of information ; yet on their appearance 
I deemed it prudent to resort to a course of mer- 
cury, under the impression that the means I had 
employed were insufficient to subdue the disease, 
and that these very symptoms were indicative of 
this fact. 

I accordingly ordered him mercurial frictions, al- 
though I confess my hopes were rather stronger 
than my expectations of deriving any advantage 
from them. They were continued near two months, 
and his complaints gradually disappeared. He was 
discharged the hospital well in the beginning of 
February, leaving me in no small perplexity at an 
anomaly I was then so little able to explain, but 
w^hich at present I find of such easy solution. 



222 PHAGEDENIC VENEREAL DISEASE. 

Case 27. — The following case, although not under, 
7ny care^ I had an opportunity of observing during 
its entire progress. The notes I give were taken 
by my pupil, Mr. Farrall, and the case is instruct- 
ive, inasmuch as it affords another instance of the 
connexion which exists between the phagedenic 
primary ulcer and the pustular eruption which forms 
secondary ulcers, and at the same time evinces the 
injurious effects of mercury both on the primary and 
constitutional symptoms of this peculiar disease, 
unless it has begun to decline. 

John M'Mahon, admitted 27th May, 1816, with 
considerable inflammation of the penis, phymosis, 
and profuse discharge. On retracting the prepuce 
as far as its inflamed condition would admit, the 
entire glans was discovered to be in a state of pha- 
gedenic ulceration. Severe pain; high symptomatic 
fever. 

He had been disordered two months, and had 
taken eighteen mercurial pills. 

He was ordered a bolus, to be taken at night, 
containing six grains of calomel and two of antimo- 
nial pow^der, which, on the 29th, was increased to 
ten grains of calomel, with the same quantity of 
antimonial powders, and a grain and a half of opium. 

This bolus was repeated every night until the 
16th of June, with but four omissions, and on these 
intervening periods, he took some opening medi- 
cine, which was continued as required until the 30th. 
The ulcer on the penis all this time was making 
progress, and on the 1st July, ulcers were apparent 
on the tonsils. He was now put on the use of 



PHAGEDENIC VENEREAL DISEASE. 223 

mercurial frictions, which he continued until the 
9th of July, when he had rubbed in seven drachms 
of ointment. However, as the disease was still 
tinchecked, the ointment was laid aside for pills of 
calomel and antimony, with occasional doses of the 
compound powder of jalap, and the fermenting 
poultice was applied to the penis. 

These medicines were discontinued on the 12th 
of August for the solution of the muriate of mercury, 
and an anodyne draught at night. On the 19th of 
August, it was noted that a number of large brown 
scabs had made their appearance on his forehead, 
chin, arms, legs, and body, at a time that he was 
under the influence of mercury. 

From tKis period until the beginning of Septem- 
ber he did not use mercury in any form ; the only 
medicine he was ordered was a pill every night, con^ 
taining two grains of ipecacuanha and one of opium, 
under which his throat improved, but the scabs en- 
larged, and he became affected with pains in his 
joints. 

The primary ulcer continued its ravages, until the 
entire penis was destroyed, which occurred about 
the middle of August, when a cicatrix formed close 
to the scrotum. 

On the 4th of September he was ordered the so- 
lutioi; of muriate of mercury and decoction of sar- 
saparilla, which soon affected his mouth. The 
scabs shortly afterwards began to drop off, leaving 
the parts underneath healed. The pains of his 
joints daily diminished, and he continued the medi- 
cine until the 3d of October, when he was discharg- 
ed well. 



224 PHAGEDENIC VEINEREAL DISEASE. 

This case was managed in every respect contra- 
rary to the plan of treatment I have recommended. 
The patient, it is true, recovered from the disease 
under the use of mercury, but in a mutilated state, 
and with a shattered constitution. 

Case 28. — William Kelly, admitted September 
6th, 1816, with a phagedenic ulcer extending from 
the corona glandis, more than half way along the 
body of the penis, and nearly round its circumfer- 
ence. It was attended with imflammation, pain, and 
symptomatic fever; — pulse 120. 

It commenced at the frenum, and spread rapidly 
under the exhibition of mercury, which the patient 
informed me had been given to so great an extent 
as six pills a day, which he persevered in a consi- 
derable time before his admission. Under my di- 
rections he was bled twice, (sixteen ounces each 
time,) and took purging and antimonial mixtures, 
which he persevered in till the 20th September; 
when the ulcer not improving, he was directed to 
take five grains of the extract of cicuta every fourth 
hour ; but the ulcer still continuing its ravages, this 
medicine was laid aside, on the 6th of October, for 
the muriate of mercurj and decoction of sarsaparii- 
la. Still the ulcer extended, until the entire pre- 
puce, and a great portion of the glans, including 
part of the urethra, were destroyed. About the mid- 
die of November the ulcer began to put on a more 
favourable appearance, but at the same time, and 
while he was under the influence of mercury, 
he was attacked with pains in his ankles and in- 
steps. The mercury was now laid aside, and he 



PHAGEDENIC VENEREAL DISEASE. 225 

was ordered, on the 25tli November, a scruple of 
Dover's powder every night, with the decoction, 
and the frequent use of the warm bath. 

Under this plan, the pains lessened and the ulcer 
improved, and finally healed before the 10th of 
January, 1817. Still the pains were lingering in his 
joints, and in compliance with his desire, I allowed 
him to rub in ^ss. of mercurial ointment every 
night, which about the end of January, excited con- 
siderable ptyalism, under which the pains were 
greatly relieved, but at the same time a large red 
tubercle appeared on the back of the right leg. The 
mercury was still persevered in, but the pains be- 
came more troublesome, and in the middle of Feb- 
ruary a large scabby ulcer had formed on the right 
arm below the elbow, and towards the end of the 
same month, his knee became swelled and inflamed. 

Under these circumstances, it was obvious that 
the mercurial plan was of little advantage to him ; 
it was therefore discontinued on the 28th of Febru- 
ary, and he was put upon decoction of sarsaparilla, 
with which he was directed to take five grains of 
gum guaiacum every forth hour, and to rub the knee 
with the ointment of tartarized antimony, which ex- 
cited as usual a crop of pustules on the part. The 
pain of his knee, as well as all the other pains, gradu- 
ally lessened under these medicines, and the fre- 
quent use of the tepid bath. The tubercle on the 
back of his leg did not ulcerate until the beginning 
of April. The same medicines were still continued, 
with little variation, and under their use all his com- 

2 F 



226 PflAGEDENIC VENEREAL DISEASE. 

plaints at length disappearing, he was discharged 
the hospital on the 19th of May. 

This case affords a good example of the phage- 
denic disease, both in its primary and secondary 
symptoms ; of the inutility of mercury for their cure; 
and of the advantages derivable from sarsaparilla 
and guaiacum, after mercury had been exhibited 
without success. 

Case 29. — The following case, though long, so 
well exemplifies the distress and danger to the pa- 
tient, as well as embarrassment and mortification to 
the surgeon, from the early exhibition of mercury 
in the phagedenic disease, that I cannot refrain from 
giving it, as I am certain it will be esteemed by the 
juniors of the profession a very useful and impress- 
ive lesson. 

In the beginning of June 1816, Mr. C. consulted 
me concerning a small foul ulcer inclined to phage- 
dena, which had appeared about a week before on 
the prepuce. I prescribed antimonial pills and the 
mercurial yellow wash, but did not see him again 
until the 12th of July, when I was called upon to 
visit him at his own house. I found him in bed, 
complaining of the most severe pain in his head, 
which was increased by the slightest noise. His 
pulse was 110. The ulcer of the penis had nearly 
healed. I directed some smart opening medicine, 
and took sixteen ounces of blood from his arm ; and 
two days afterwards leeches were applied to his 
temples. On the 22d, the pain not remitting, the 
physician who attended his family was consulted, 
who advised a continuance of the cathartic raedi- 



PHAGEDENIC VENEREAL DISEASE. 227 

cines, and diaphoretics at night. On the 28th aijd 
29th he complained of pain in a part of his forehead, 
which was tender upon pressure, and the same ten- 
derness and pain also attacked one of the clavicles. 
The ulcer of the penis, which had healed, began 
again to ulcerate, and a few large piniples or pus- 
tules, of a suspicious aspect, had appeared on his 
forehead, arm, and back. In four or five days after- 
wards, the spots had extended into ulcers covered 
with crusts. 

As it was now apparent that the high fever with 
which he was attacked was a venereal eruptive fe- 
ver, which preceded the appearance of the pus- 
tular spots, I hoped to stop the progress of the dis- 
ease by the exhibition of mercury, which I combin- 
ed with antimony, on account of the high degree of 
excitement which still continued. With these views 
I therefore ordered for him, on the 30th, pills con- 
taining a grain of calomel, with two of antimonial 
powder, to be taken thrice a day. I, however, was 
perfectly aware from the symptoms, that I had a 
difficult disease to manage, and gave the patient an 
«arly intimation of the obstinate nature of his disor- 
der. 

Aug. 8th. — His mouth was affected by the mer- 
cury ; the ulcer of the penis had increased, and ex- 
hibited a burrowing disposition. The constitution- 
al ulcers, four or five in number, had also extend- 
ed ; he complained of pain in the back of his neck, 
and in his left knee. Decoction of sarsaparilla was 
now added to his former prescription. On the 14th, 
the pain of the knee had considerably increased, 



228 PHAGEDENIC VENEREAL DISEASE. 

and was attended with puffiness on each side of the 
ligament of the patella. This symptom was reliev- 
ed in a few days by hot fomentations and warm poul- 
tices of bread and water, and he had also ceased to 
complain of his head and clavicle. 

18th. — The gums were much swelled, and the 
ptyalism was considerable ; but the ulcers continu- 
ed to extend, and the crust covering that on his 
forehead, the base of which was nearly as large as 
a shilling, exhibited the conical form and appear- 
ence of a limpet shell, as delineated in the plate. 
The right testis had also become swelled and pain- 
ful. As the disease, instead of being checked by 
the mercurial affection of the system, was decided- 
ly making advances, as was evinced by the exten- 
sion of the constitutional ulcer and the appearance 
of new symptoms, the mercury was discontinued ; 
but on the 28th, his complaints being stationary, he 
was directed one-eighth of a grain of muriate of mer- 
cury, thrice a day, with the compound decoction of 
sarsaparilla. 

Sept. 12th. — The swelling of the testis had in- 
creased, and no amendment had taken place in his 
other complaints. The solution of the muriate of 
mercury was changed for pills thrice a day, contain- 
ing one-half grain of calomel, and two grains of an- 
timonial powder. Decoction as before. 

Oct. 4th. — The crusts had fallen from all the 
spots, leaving the parts underneath healed. The 
testicle, however, remained as it was. His mouth 
was slightly affected. It was now thought advise- 
able to increase the mercurial affection of the sys- 



PHAGEDENIC VENEREAL DISEASE. 229 

tem, with the view of dispersing the swelling of the 
testis. He was, therefore, ordered four grains blue 
pill, with one-half grain calomel, thrice a day, and 
on the Bth he was directed to discontinue the pills, 
and to rub in 5i. of ointment every night, which, 
on the 14th of October, affected his mouth severely. 

The mercurial affection of his system w-as ob- 
viously, however, a second time attended with the 
most injurious effects ; for the spot on his forehead 
had again ulcerated, and a new pustule, which ex- 
tended into an ulcer, had appeared on one of his 
cheeks. The testicle had increased in size, and 
he began to complain of severe deep-seated pain 
in one of his thighs, and felt, according to his 
account, as if it proceeded from the bone. The 
mercurial plan of treatment was, therefore, again 
laid aside, and he was ordered the compound decoc- 
tion of sarsaparilla, with ten grains of Dover's pow^ 
ders, thrice a day. An endeavour was made to re- 
lieve the pain of the thigh by the use of the tartariz- 
ed antimonial ointment ; this treatment was follow- 
ed by a crop of pustules on the part, and afforded 
him considerable relief. At this period, as the pa- 
tient lived in an unhealthy and crowded part of Dub- 
lin, he was advised to change his residence for one 
in the environs of the city, but this measure was 
not adopted, although its necessity was urged to 
him and his friends in the strongest manner. 

The ulcer on his forehead had increased to such 
a degree as to extend from his hair to the root of 
the nose, and was about three-fourths of an inch in 
breadth. The upper part presented large, loose, 



230 PHAGEDENIC VENEREAL DISEASE. 

spongy granulations, but the lower was spreading 
and phagedenic, and I greatly feared it would ex- 
tend to the loose cellular structure of the eye-lids. 

I therefore thought it adviseable to destroy, if pos- 
sible, the surface of the ulcer, and induce a new ac- 
tion in the part, by touching it daily with a strong 
solution of nitrate of silver. It was also applied to 
the smaller ulcer which was on his cheek, and ex- 
hibited much the same appearances. 

This application was attended with advantage, 
for on the 9th November, it was noted that the ul- 
cer had a healthy healing appearance at its lower 
part. It, however, exhibited loose, spongy granula- 
tions above, but the smaller ulcer was nearly healed. 

November 1 9th.— The ulcer continued to contract 
in size, but it was not healing to my satisfaction, as 
the granulations were soft and spongy. The testi- 
cle remained undiminished in size, and on its upper 
part had formed a small abscess, which broke and 
discharged some pus. 

As upwards of a month had elapsed since the 
mercury was discontinued, the patient became dis- 
contented that something more efficient was not do- 
ing for him, particularly as his complaints remain- 
ed so nearly stationary ; and I myself, hoping that 
an alterative plan of mercury, combined Avith the 
woods, might produce a beneficial change, directed 
4 grs. of the mercurial pill twice a day, which on 
the 27th was increased to thrice a da}^ ; but on the 
5th December, it became necessary to abandon 
mercury for the third time, because it was appa- 
rent, although his ^ums were now severe! v affected, 



PHAGEDENIC VENEREAL DISEASE. 231 

that the ulcer on his forehead was making advan- 
ces, and he was again complaining of the deep-seat- 
ed pain in the femur. 

All mercury being therefore discontinued, he was 
put upon the use of nitrous acid. Upon this plan 
he continued until the 15th December, during 
which time the ulcers gradually amended, but the 
testicle became more swelled, and extremely painful. 

As venereal swellings of the testicle are, above 
all other symptoms, most apt to yield to mercury, 
a cautious trial was again made of that medicine. 
The patient was directed to rub in half a drachm of 
ointment at night, and to take l-8th of a grain of 
the muriate of mercury twice a day. 

On the 22d December, the symptoms all getting 
worse, a consultation was held with a surgeon of 
eminence, who was made acquainted with the per- 
plexing circumstances of this obstinate case, the re- 
peated trials of mercury, and the reiterated disap- 
pointments which followed its use. He, however, 
recommended a steady and gradual exhibition of 
that medicine in the form of friction, and a more 
powerful application of lunar caustic to the ulcer, 
and that the patient should at the same time enjoy 
the benefit of country air. 

This plan was strictly followed, and in order to 
prevent too sudden an affection of his mouth, he was 
directed to rub in but half a drachm every night : 
however, before the end of January his mouth was 
strongly affected by the mercury. But at this pe- 
riod, and while the medicine had full possession of 
the constitution, the testicle began to grow intoler- 



232 PHAGEDENIC VENEREAL DISEASE. 

ably painful, and the ulcer of the forehead, which 
had been checked at its lower part, was again ex- 
tending towards the scalp, b}^ undermining the 
skin. He also repeated his complaints of severe 
pain in the head and shoulders. Under these cir- 
cumstances, it was determined, in consultation with 
the same gentleman, to discontinue the mercury, and 
apply three leeches daily to the testis, until the pain 
subsided. But unfortunately, the leeches, instead 
of diminishing the pain and swelling of the testis, 
excited so much irritation as to produce consider- 
able inflammation, and an extensive slough of the 
scrotum; and the symptomatic fever ran so high, 
that it became necessar}^ to take blood more than 
once from the arm. 

After the separation of the slough, the greater 
part of the right testis became exposed, and the 
ulcer produced was of a most irritable nature ; with 
this, different lenient applications were tried, but 
the great irritability of the part could only be re- 
lieved by anodynes. In the mean time the ulcer 
on his forehead continued, in its superior part, to 
gain ground by undermining the integuments of 
that portion of the scalp adjoining the forehead, and 
he was again put on the use of nitrous acid. 

February 9th, 1817. — The gentleman who saw 
him before, and another surgeon, met me in consul- 
tation this day, when it was determined to add to 
the nitrous acid one-third of muriatic acid, so as 
that the mixture should correspond with that re- 
commended by Dr. Scott. It was also agreed to 
touch the edges of the ulcer of his forehead daily. 



PHAGEDENIC VENEREAL DISEASE. 233 

with the oxymel ^eruginis, and to procure rest by 
means of anodynes. At this period the patient was 
obliged to remain in bed, not only on account of his 
great debility, and emaciation, but from the very 
painful state of the exposed testis, which was in- 
creased by the slightest motion. His pulse was in 
general about 110. His friends were anxious that 
he should try a patent medicine, De Velno's vege- 
table Balsam, with which I willingly complied, as I 
had seen in other instances, where mercury had 
been given extensively, and without benefit, appa- 
rent advantage from the use of this medicine. On 
the 20th February, he commenced with a wine-glass 
full thrice a day, which was afterwards gradually 
increased to such quantity as his stomach and bowels 
could bear. He continued to take it for several 
months, during which time it did not excite the 
slightest tenderness of the gums, or foetor of the 
breath. These circumstances I mention, as they 
evince that this medicine does not contain, as is ge- 
nerally supposed, any portion of mercury.* 

It is but candid to acknowledge, that immediate 
and decisive amendment ensued on the exhibition 

* Such evidence is certainly far from being conclusive, inasmuch 
as the Oxymurias Hydrargyri may be exhibited in moderate doses 
for months without aifecting" the gums or breath. This observa- 
tion will apply with equal force to certain panacea's^ which have 
lately been palmed upon the American public, as entirely of vege- 
table composition. The effects which these nostrums often exert 
upon the gums and breath, their ordinary influence upon the system, 
and operation in certain chronic diseases, with many other cir- 
cumstances which might be adduced, evince to those who are 
familiar with the effects of the Oxymurias Hydrargyri, that it is 
to this valuable mercurial salt, all the good and barm they do i^ 
attributable. E. 

2g 



234 PHAGEDENIC VENEREAL DISEASE. 

of this patent medicine. His appetite and strength 
improved, the ulcers became clean, and began to 
lose their irritable phagedenic edges, and by the 
end of March were more than two-thirds healed. 

About this time, however, new symptoms arose 
to damp our expectations ; pain and tenderness oc- 
curred in both tibiae, which prevented him from 
walking, and deprived him of his rest at night, un- 
less he took a dose of Dover's powders. With De 
Velno, he was ordered to take daily a pint of strong 
decoction of sarsaparilla, and he went into the tepid 
bath every alternate day. 

About the middle of May, the ulcer of the scro- 
tum had cicatrized, but a small portion of that on 
his forehead still remained, without showing any 
disposition to heal. He continued to take De 
Velno and the decoction of sarsaparilla, until the 
middle of June, during which time numerous spots 
of a pustular character appeared on his face, and a 
few on his body ; but instead of degenerating into 
ulcers, they desquamated into broad scaly patches 
of a copper colour, very different, however, in cha- 
racter, and appearance, from the syphilitic lepra. 
Great pains and tenderness of the tibiae continued 
to disturb him, attended with puffiness of some 
parts, as if the periosteum was diseased. The 
knees, also, became so tender and painful that he 
could not stand. The ulcer on his forehead had 
contracted to the size of a sixpenny piece, and ex- 
hibited a smooth red fungous surface. 

June 21st. — He wns attacked with severe pain in 
the ri2;ht testicle, and the right iliac region, which 



PHAGEDENIC VENEREAL DISEASE. 235 

yielded to a dose of castor oil, warm fomentations, 
and six leeches applied to the testicle. The aspect 
now assumed by the eruption, accurately corre- 
sponded with those appearances, which I had fre- 
quently known to give way before the influence of 
mercury. I therefore determined upon a cautious 
trial of blue pill ; but unfortunately it disagreed with 
his bowels, and was therefore laid aside for the pre- 
sent, as was also De Velno, which seemed not to 
produce any good effects during the last month. 

On the 5th of July, I saw him in consultation 
with two professional gentlemen, who had not be- 
fore been consulted. After considering the many 
embarrassing circumstances of this intricate case, 
the result of the consultation was, that he should 
again have recourse to De Velno, and to continue 
the Iceland moss, and ass's milk, which he had been 
previously ordered, but that as soon as his strength 
had improved, that a cautious trial of mercury 
should again be made.^ He continued on this plan, 
neither getting better nor worse, till early in the 
following August, when I conceived that the mer- 
curial process determined upon by the last consul- 
tation, might with propriety be commenced. At 
this juncture I received a letter from my patient, 
informing me that he had placed himself under the 
care of another professional man, the second who 
was consulted on his case. From this gentleman 

* One of these gentlemen, a surgeon of long experience and 
extensive practice, observed on this occasion, that in his day, 
practitioners had but little perplexity with such cases, for that 
they persevered in the use of mercury whatever were its effects, 
till it solved every difficulty by curing or killing the patient. 



236 



PHAGEDENIC VENEREAL DISEASE. 



I afterwards learned that the symptoms yielded 
gradually, and without any farther embarrassment, 
to a course of mercurial friction. 

The premature use of mercury was the cause of 
all the distressing and embarrassing circumstances 
which attended this case. If antimony and sarsa- 
parilla had been persevered in with steadiness, un- 
der confinement, the patient would probably have 
recovered in the course of eight or ten weeks, and 
with but little suffering, compared to that which he 
underwent after the fever had been superseded, and 
the eruption checked by the use of mercury. 

The only period that this medicine ought to have 
been employed, was when the eruption had become 
scaly. But although mercury was unwisely exhi- 
bited too soon in the present instance, yet whenever 
it was found to disagree, it was discontinued for a 
time. This moderation, w^e shall find, was not ob- 
served in the following case of a similar description, 
and the result was of a much more lamentable cha- 
racter. 

Case 30.— On the 5th of April, 18 17, 1 was called 
upon to meet tuo practitioners in consultation, one 
of whom, the attendant in the present instance, was 
the surgeon who brought the case I have just de- 
tailed to so favourable a termination. 

The subject of our consultation was Mr. S., a 
gentleman about 3v0 years of age, who was affected 
•at the time with both primary and secondary symp- 
toms. The former Were decidedly phagedenic. The 
latter exhibited spots covered with thick conical 
crusts, like the limpet shell in figure, scattered over 



PHAGEDENIC VKNEREAL DISEASE. 237 

his face, back, and sides, and these larger crusts 
were intermingled with pustules and smaller scab- 
by spots. 

I learned that about five months previous to my 
visit, the disease commenced on the prepuce. — Mer- 
cury had been resorted to, and the ulcer extended 
under its use until the entire prepuce was destroyed. 

It being found that the disease was not to be sub- 
dued by that medicine, I understood it had been 
laid aside for decoction of sarsaparilla, and the ulcer 
was induced to heal under the application of butter 
of antimony and lunar caustic. — Some short time 
afterwards, the ulcer had again broken out, and 
was followed by the constitutional symptoms I have 
described. The patient was again put upon a course 
of mercury; and at first under its use, the sj^mptoms 
seemed to amend ; but as soon as the system be- 
came fully impregnated with that medicine, new 
symptoms appeared, and the old ones became worse. 
A third mercurial process was tried with precisely 
the same result At the period of the consultation, 
that medicine had been just discontinued, and the 
patient was taking decoction of sarsaparilla with 
Fowler's solution of arsenic, which I was informed 
had in a very short time produced a favourable 
change. Under these circumstances, I advised a 
continuance of the plan he was upon, and in the 
strongest manner stated my objections to the far- 
ther use of mercury, from my experience of its in- 
jurious effects upon every case I had met, which 
exhibited the same character of primary or consti- 
tutional symptoms. 



238 PHAGEDENIC VENEREAL DISEASE. 

I never afterwards saw the patient, but I learned 
that mercury had again been essayed, and course 
after course persevered in, till the patient was re- 
duced to the lowest ebb, without deriving any far- 
ther benefit from these repeated attempts than a 
removal of the disease from the skin to the bones. 

He was then sent to Lisbon, as a last resource, 
where he soon ended his days ; and thus unhappily 
perished a most promising young member of the 
Irish bar, eliually remarkable for the extent of his 
attainments, the quickness of his intellect, and the 
brilliancy of his wit 

These cases sufficiently evince the virulence and 
obstinacy of that species of venereal disease which 
is attended by a pustular eruption, terminating in 
ulcers covered by conical crusts; and decidedly 
prove the impropriety of the present practice of 
interrupting the natural progress of the complaint? 
by the exhibition of mercury, before the cessation 
of the eruptive fever, or the manifest decline of the 
disease. This declension may be clearly inferred, 
when any of the constitutional ulcers have healed, 
or when any new spots or pustules which occur, 
have terminated in desquamation, or extended into 
scabby blotches, instead of assuming or preserving 
the form of ulcers covered with thick conical crusts. 

Cases exemplifying the ejicacy of the plan of treat- 
ment recommended for the constitutional symptoms 
of the phagedenic disease^ many of which exhibited 
at the same time the primary symptoms. 

Case 31. — Michael Malone, admitted August 5th, 



PHAGEDENIC VENEREAL DISEASE. 239 

1812, on account of an extensive phagedenic ulcer, 
irregular and irritable, engaging the whole upper 
surface of the glans penis, one half of which was at 
least destroyed by its ravages. The surrounding 
prepuce was of a bluish colour, as if ready to fall 
into a sloughing state. He complained of severe 
pain in the part, particularly at night, which pre- 
vented him from resting. On examining his throat, 
I found superficial ulceration on the back part of 
the pharynx. There was no other appearance of 
secondary symptoms. 

He stated, that he had been admitted into the 
Lock Hospital the preceding Jamiary, where he 
had remained eleven weeks, during which period, 
he rubbed in seven ounces of ointment, which sali- 
vated him severely ; that under its use the original 
sore healed, but immediately another broke out, and 
a succession occurred, till at length he was dis- 
charged, labouring under the present ulcer, for the 
benefit of country air; that during his absence he 
also used mercury, which at first had been of ser- 
vice, but that the ulcer again became worse, as soon 
as salivation commenced. 

I desired him to keep a poultice of bread and 
water to the penis, and to take pills containing five 
grains of extract of cicuta three times a day, which 
on the 10th were increased to ten grains. He was 
also directed to take decoction of sarsaparilla. 

17th. — The pain was considerably lessened, and 
the entire ulcer was improved ; and on the 27th, it 
was completely healed, and he was discharged the 
hospital. He returned to it, however, on the 29th 



240 PHAGEDENIC VENEREAL DISEASE. 

of November following, with a painful and oede- 
matoiis swellins; on the lower part of the leg, ex- 
tending over the tibia, which either seemed to be 
slightly enlarged, or the periosteum affected. This 
complaint came on six weeks before his present 
admission. He also complained of pain in his right 
hip and elbow; his tongue was foul, and appetite 
bad. I therefore ordered him a smart opening 
medicine, and after its operation, to take antimonial 
solution, and decoction of sarsaparilla. He was also 
directed to keep cloths moistened in saturnine lotion 
to the tumour on his leg. 

Dec. 10th. — He was ordered fifteen grains of the 
compound powder of ipecacuanha, night and morn- 
ing, and to continue the decoction. Under this plan, 
in the course of a week, the tumour of his leg was 
considerably reduced; his throat became well, his 
appetite improved, and on the 28th, he was dis- 
charged the hospital, perfectly well. 

Case 32. — Peter Murphy was admitted July 13th, 
1313, on account of a deep foul ulcer, covered with 
white viscid matter, which engaged the back of the 
pharynx, as far as it could be seen. He stated, that 
he had been in the hospital two years before, for 
pains in his breast, head, and shoulders, and an ul- 
cer on his right arm, the cicatrix of which, on ex- 
amination, I found to be as large as the palm of the 
hand — that he was severely salivated during three 
months which he had remained in the hospital, and 
was discharged apparently well — that the disease 
some time afterwards appeared in his throat, for 
which, he was again taken into the hospital, a year 



PHAGEDENIC VENEREAL DISEASE. 241 

after he had left it — that he remained in it five 
weeks, during which period, he was again salivated 
severely, and discharged the hospital a second time, 
apparently well ; and that two months after he left 
it, his throat became again ulcerated. 

The inadequacy of mercury to remove the dis- 
ease, as was apparent from the former trials he had 
made of that medicine, induced me to order him 
antimonial solution and decoction of sarsaparilla. 

19th. — The appearance of the ulcer was unalter- 
ed ; he stated, however, that it was less painful. 

26th.— The ulcer was very much improved, and 
was healing round the edges. 

August 3d.-^The ulcer was nearly healed, and 
on the 9th, he was discharged the hospital well, and 
has not since returned. 

Case 33. — James Carroll, admitted April 27th, 
1815: — ^An extensive ulcer of the glans surrounded 
the orifice of the urethra. Ulcerated bubo in the 
right groin. He stated that he was four months 
disordered, during the entire of which period he 
had been using mercury, which kept his mouth con- 
tinually sore. Solut. Antim. — Catapl. — During the 
first week in May, several spots covered with crusts 
had appeared on his back, shoulders, and forehead. 
The ulcer on the penis had become more irritable, 
on which account the antimonial solution was dis- 
continued for five grains of extract of cicuta thrice 
a day. 

May 18th. — A small white excavated ulcer had 
appeared on his left tonsil. 

The primary as well as constitutional ulcers re- 
2 H 



242 PHAGEDEXIC VENEREAL DISEASE. 

mained obstinate for a considerable time — that on 
his forehead extended to the size of a shilling, and 
was particularly foul ; but under the exhibition of 
tlie sarsaparilla and antimonial solution, which lat- 
ter medicine was ordered again on the 5th of June, 
they were healed before the 26th of the same month, 
when he was discharged the hospital. 

He was, however, re-admitted on the 23d of July, 
on account of pains in different joints. For these 
he was ordered the pills of antimonial powder and 
calomel, under which he soon became well and was 
discharged again on the ^th of August. 

Case 34. — Michael Bannister, admitted June 20, 
1815: An extensive ulcer of phagedenic character 
engaged the corona, superior surface of the glans, 
and what remained of the prepuce. The glans ap- 
peared to have passed through a large ulcerated 
opening i-n the prepuce ; the remnant formed a tu- 
mour which lay at the frenal side of the glans. The 
whole penis was inflamed; high symptomatic fever 
— pulse 120 — ^his mouth was affected with mercury. 

He stated that he was six months disordered, 
that he lay part of the time in the infirmary of Liver- 
pool, where he underwent a course of mercurial 
frictions during five or six weeks; but the ulcer 
not healing, he left the hospital and came to Dub- 
lin; that after his arrival in this city he again com- 
menced the use of mercury, which he had been ta- 
king three weeks immediately previous to his ad- 
mission. Mitt. Sanguis ad 3xvi. — Solut. Antim. — 
Fotus. — CatapL 

22nd. — Repet vensesectio ut antea. 



PHAGEDENIC VENEREAL DISEASE. 243 

26th. — Pain excessive; the ulcer had made so 
great progress that the glans appeared as if it was 
about to separate from the body of the penis. Pulse 
120. His mouth was still affected by mercury. Mitt. 
Sanguis ad §xvi. 

July 3d. Pain and irritation severe, no rest. He 
was directed to take every sixth hour a pill con- 
taining four grains of the extract of cicuta, with one 
of opium, and sixteen ounces of blood were taken 
from his arm. 

After this, the pain was considerably reduced, 
and the ulcer assumed a less irritable appearance. 
The irritation, however, was still considerable, and 
appeared to me to be excited by that portion of the 
prepuce which I have already described as forming 
a useless mass behind the glans. This tumour I 
removed on the 28th of July with the knife, and all 
irritation afterwards ceased. The amendment was 
now decided and progressive, and the glans, which 
appeared in so dangerous a state, was preserved, 
but the ulcer had burrowed under the skin of the 
penis to a considerable extent. 

On the 1st of September he was affected with 
several tubercles on his legs and thighs, similar to 
those delineated in Plate I. fig. 4, 5, 6. These af- 
terwards spread into deep foul ulcers with over- 
hanging edges. 

When the tubercles appeared, he was put on the 
use of nitrous acid, in which he persevered until 
the latter end of October, when all the ulcers hav-- 
ing perfectly healed, he was discharged the hos- 
pital. 



9||| PHAGEDENIC VENEREAL DISEASE. 

Case 35. — John Molloy, admitted December 7th, 

1815, with phymosis. Ulcers of phagedenic ap- 
pearance on the prepuce and surrounding its orifice 
— pain and swelling of the left knee. He had been 
disordered three months, and stated that he had not 
used mercury. Solut. Antim. — Fotus. — CatapL 

Jan. 20th. — Ulcers' improved; but he complain- 
ed of pains in his different joints. Lot. Hydrarg. 
Nigra. 

February 18th. — The ulcers healed. Pains less- 
ened. 

March 3d. Discharged well. 

Case 36. — John Haydon admitted March 20th, 

1816, with an extensive phagedenic ulcer on the 
external surface of the prepuce. There was also 
on the abdomen a constitutional ulcer somewhat 
larger than a dollar ; it exhibited an irregular pha- 
gedenic margin, but showed a disposition to heal at 
the centre. He stated that he was five months dis- 
ordered, and that he had been severely salivated by 
pills which he took for six weeks. Solut. Antim. 
— Decoct. Sarsap. — Fotus. — Catapl. 

April 15th. — The ulcer of the penis continued 
much in the same state, extremely painful and oc- 
casionally sloughy. He was ordered a pill every 
eighth hour containing three grains of extract of 
cicuta and half a grain of opium. 

23d. — The ulcer of the penis considerably im- 
proved, that on the abdomen healing rapidly from 
the centre. 

May 13th. — The ulcer on the penis healing, that 
on the abdomen had healed. Decoct. Sarsap. 



PHAGEDENIC VENEREAL DISEASE. 245 

June 7th. Discharged well. 

Case 37. — Hannah Clarke, admitted May 24th, 
1815: — an eruption of ulcers covered with crusts, 
some flat and others conical, on every part of her 
body. The largest of these spots was situated on 
her upper lip, which was nearly covered by a crust 
similar to that in plate IV. There were also two 
small aphthous ulcers on the velum. 

The only circumstance which could be learned 
from the confused account which she gave of her 
complaints was, that she was affected with severe 
pains in her joints, which left her oh the appearance 
of the eruption. 

She was ordered a strong decoction of guaiacum 
wood with twenty drops of antimonial wine three 
times a day ; under this plan she continued with 
little variation as long as she remained in the hos- 
pital. For some time he^ debility was extreme^ a 
circumstance remarked in all the other cases. At 
length gradual slow amendment was observable by 
the falling off of the crusts, which left the parts un- 
derneath them perfectly cicatrized. 

She was free from all complaints on the 18th of 
July, but was allowed to remain in the hospital un- 
til the 21st of August, pajrtly on account of her ema- 
ciation and debility, and partly because I was desi- 
rous to ascertain whether any other symptoms of 
the disease would occur. 

Case 38. — Laurence Reynolds, admitted 24th 
Deceml^er, 1815, with large ulcers covered with 
thick crusts, situated on his trunk, legs and thighs. 
Three or four of those were without crusts, but 



"246 PHAGEDENIC VENEREAL DISEASE. 

with a phagedenic edge. An ulcer extended along 
the tarsus of the right eye-lid, which was consider- 
ably swollen. A large node was situated on the low- 
er end of the left tibia, and he complained of severe 
pain in his head. 

He stated that the primary ulcer on the penis, 
which occasioned these complaints, occurred so 
long back as four years before his admission, and 
was healed under the exhibition of corrosive subli- 
mate : — that an interval of two years took place be- 
fore any constitutional symptoms appeared, which 
were similar to those he then laboured under, and 
for which he was admitted into the Richmond Hos- 
pital, where he underwent a full course of mercury, 
of nine weeks' duration, which removed all his com- 
plaints, but that they began to appear again in less 
than a month after he was discharged; that he was 
again admitted in the preceding February into the 
same hospital, where he was kept under the influ- 
ence of mercury during fourteen weeks, which, a 
third time apparently cured his complaints, but that 
in a very short time they re-appeared in the extent 
and form already described, when he applied to me. 
I directed for him the compound decoction of 
sarsaparilla, and the following pills : 
R. Gum. Resin. Guaiaci ^i.ss. 

Pulv. Antim. jss. 

Ft. Pilul. xxiv. 

Capt. Un. 4a. qq hora. 
Repeated blisters were also applied to the node 
on the tibia, and the discharge from the part pro- 
moted bv savin ointment 



PHAGEDENIC VENEREAL DISEASE. 247 

There was not the slightest variation made in 
this plan, as long as he remained in the hospital. 
His amendment proceeded in a gradual and unin- 
terrupted manner, except that a second node ap- 
peared on the ulna, to which blisters were also ap- 
plied. The crusts did not fall from some of the 
spots until the ulcers were healed, while those that 
were exposed to view healed in the manner I have 
so often mentioned, from the centre. On the 15th 
of February, 1816, he was discharged the hospital 
well. 

Case 39. — In January 1818, 1 was called upon to 
see an elderly gentleman on account of an extensive 
phagedenic ulcer which had committed sad ravages 
on his glans and prepuce. — They presented an irre^ 
gular surface either indented with existing ulcera- 
tion, or the cicatrices of that which had lately heal- 
ed. His urine passed through an ulcerated opening 
in the urethra, all the under part of the glans includ- 
ing the urethra being destroyed by the ulcer, which 
was still gaining ground. 

He had frequent desire to pass water, at least 
every half hour, probably in consequence of the 
irritation of the extremity of the urethra. There 
were two or three ulcers covered with crusts on his 
back and shoulders. He was greatly emaciated, 
although naturally robust, and was under the influ- 
ence of mercury:— -pulse 112, great thirst, and gene- 
ral symptomatic fever. 

He had been six months disordered. During the 
entire of this period he was using mercury both in 
the form of pill and ointment, under the direction 



24$ PHAGEDENIC VENEREAL DISEASE. 

of an apothecary, so extensively as to keep up a con- 
stant mercurial irritation in the system. His medical 
guide at length finding himself completely bewil- 
dered under the evident failure of his specific, though 
administered neither sparingly nor remissly, told the 
patient to desist from its farther use, that the virus 
was totally eradicated, and that nothing more was 
requisite to his perfect recovery but wine and nour- 
ishing diet. 

This unfortunate and worn-out gentleman, accord- 
ingl}^ began to take a bottle of wine daily, and as 
much animal food as he could swallow, which it 
may readily be supposed was not much; but he 
found his fever and debility, and every complaint 
that he was assured was eradicated, increasing under 
this strengthening regimen, till at length he con- 
ceived it prudent, late as it was, to seek for advice. 
It was on this occasion that I was consulted. 

I directed him in the first instance to remove from 
about him every thing tainted with mercury; to get 
into a tepid bath, to take some opening medicine, 
a frequent saline draught, and an anodyne at night. 
The latter was necessary on account of the fre- 
quency of passing water, and the general irritabili- 
ty of his frame. — Under this plan, in a few days, one 
great source of his distress, the frequency of passing 
water, was removed. His thirst and general fever 
were, however, very considerable, and the ulcer, 
though slowly, continued to gain ground. I directed 
for him the decoction of sarsaparilla with fifteen 
drops of Antimonial wine three times a day. 

On the 28th of January, I removed with the knife 



PHAGEDENIC VENEREAL DISEASE. 249 

several projecting portioDs of the edges of the ul- 
cer, which were jagged, and shewed by their livid 
colour a tendency to slough or ulcerate. The bleed- 
ing from the part was then encouraged with warm 
water. He found it of the greatest advantage, for 
the pain of the ulcer was that night considerably 
abated, and the ulcer afterwards gradually improv- 
ed in appearance. Early in February he was at- 
tacked with severe pain and swelling of the knee 
joint, which increased on the slightest motion. This 
symptom (one of the most formidable when encoun- 
tered with mercury) gave way to the application of 
leeches, twenty of which were applied on two suc- 
cessive days. The knee was also frequently fo- 
mented with hot water; and poultices of moistened 
bread, in the intervals of stuping, were kept to the 
part. On the 20th Feb. he was so much recoverd 
from this, as well as all his other symptoms, that 
he was able to walk about his room without pain or 
inconvenience. The antimonial wine was discon- 
tinued for a drachm of powdered sarsaparilla, thrice 
a-day. 

March 1st. — All the ulcers had healed, and his 
appearance, strength, and appetite greatly improv- 
ed. From this period he went abroad daily, and 
soon regained his former robust health and appear- 
ance. However he was not yet exempt from dis- 
ease, for on the 25th of April, he called to show me 
an ulcer, of foul appearance, about the size of a six- 
pence, which had appeared on his chin. I directed 
him again to recur to the powder and decoction of 
sarsaparilla. This, however, he neglected to do, 

2i 



25b PHAGEDENIC VENEREAL DISEASE. 

thinking that the ulcer would spontaneously heal ; 
but he again applied to me on the 9th of May, at 
which time it had extended to the size of a shilling, 
was deep and foul, and the entire jaw swelled and 
inflamed. I directed him to poultice it with bread 
and water, and renewed my injunctions as to the sar- 
saparilla. On the 1st of June the ulcer was perfect- 
ly healed, and he has since had no return of his 
complaints. 

Case 40. — John Murray, admitted June 1st, 1818, 
with a phagedenic ulcer of the glans and internal 
surface of the prepuce, the entire margin of which 
had been destroyed by the ulceration. The penis 
was greatly inflamed and swollen ; he complained 
of the most severe pain, which was sufficiently indi- 
cated by the extent of the symptomatic fever under 
which he laboured. Five weeks previous to his 
admission the ulcer commenced on the corona, for 
which he had taken about twenty mercurial pills, 
which had not afl*ected his mouth. He was order- 
ed the antimonial solution in nauseating doses ; the 
bread and water poultice was applied to the penis, 
and sixteen ounces of blood were immediately ta- 
ken from his arm. This depletion was repeated on 
the 2d, 5th, 7th, and 12th of the same month. The 
blood was buffy on these several occasions, and each 
venaesection was succeeded by an alleviation of 
pain, and diminution of symptomatic fever : but 
every recurrence of acute pain, according to my 
views, indicated the necessity of using the lancet. 

Under these active measures the pain and inflam- 
mation were at length reduced, and the ulcer be- 



PHAGEDENIC VENEREAL DISEASE. 251 

gan to put on a more favourable appearance ; but 
he, at the same time, began to complain of difficulty 
of swallowing, and a deep excavated ulcer discov- 
ered itself upon each tonsil. 

On the 15th, I directed decoction of sarsaparilla, 
and the black mercurial wash to the ulcer. 

On the 22d, he took the powder of sarsaparilla 
with the decoction, in place of the antimonial solu- 
tion. Under this plan the ulcers of his throat were 
perfectly healed on the 7th of July, and the ulcer 
of the penis exhibited the appearance of a mild, 
healing, granulating sore, which healed before the 
20th of July. 

Case 41. — J. Buckley, admitted January 13th, 
1822, on account of phymosis and violent inflam- 
mation of the entire penis, profuse discharge from 
under the prepuce, pulse rapid, with thirst and rest- 
lessness. He had also four or five pustular spots 
on his left arm. 

Mitt, sanguis ad. ixx. — Solut. Antim. — Catapl. 
He was directed to inject warm water frequently 
between the prepuce and glans. 

14th. — The vensesection was repeated. 

15th. — The inflammation of the penis was less- 
ened, but an ulcer was discovered on the left ton- 
sil, and the spots on the arm were becoming crusted. 

Decoct. Sarsap. cum Acido Nitrico. 

18th. — The inflammation was so far reduced as 
to admit of the retraction of the prepuce, when an 
ulcer of the phagedenic character was discovered 
on the glans. Pustular spots had appeared on his 
head, face, and thighs ; the crusts of those on his 



252 PHAGEDENIC VENEREAL DISEASE. 

arm had assumed the conical limpet-shell appear- 
ance. 

Decoct. Sarsap. cum Acido Nitrico, ut antea. 

Pulv. Ipecac. Comp. gr. xv. o. n. 

Feb. 12th. — The ulcer of the penis had healed, 
leaving a deep indented cicatrix ; several of the co- 
nical crusts had fallen off, disclosing the surface un- 
derneath healed, but red. The ulcer of the throat 
had been healed for some days. 

April 1st. — Discharged well. 

We had ceased to take notes in the hospital in 
consecjuence of there being so little necessity to 
vary the treatment; that which I have detailed suc- 
ceeding in every instance. However, during the 
winter of 1823-4, while I was employed in giving 
clinical lectures to the hospital class, the two fol- 
lowing cases of phagedenic disease were admitted ; 
and as they excited considerable interest among the 
pupils, many of whom, educated by masters of the 
old school, insisted that the cases never could re- 
cover without the aid of mercur}, I had them noted 
by Mr. Belton, my resident pupil in the hospital, 
now a licentiate of the College of Surgeons, and the 
notes were read on lecture-days while the patients 
were under the scrutinizing eyes of the mercurial- 
ists as well as the non-mercurialists of the class. 

The following is the statement of these cases ta- 
ken from the case-book, but somewhat abbreviated. 

Case 42. — Edward Brennan, aged 25, admitted 
the 20th of November, 1823, on account of the fol- 
lowing symptoms. An extensive phagedenic ul- 
cer with irregular edges, and partly covered with 



PHAGEDENIC VENEREAL DISEASE. 253- 

sloughs, engaged the right side of the glans, and ex- 
tending underneath half round the penis, had made 
an opening into the urethra, through which all his 
urine passed. The orifice of the urethra was en- 
gaged in this extensive ulcer. There was also a pain- 
ful ulcerated bubo in his right groin. There were 
numerous spots covered with thick crusts, situated 
on his arms, thighs, and scalp, and also a foul and 
extensive ulcer covered with white slimy matter, 
engaging one-half of the lower lip, which, from the 
frequent motion of the part, excited much pain and 
uneasiness. He looked pale, worn out and ema- 
ciated, and stated that eight months previous to his 
admission, a small ulcer had appeared on the glans, 
which was followed by a bubo in each groin which 
suppurated, that he put himself under the care of 
some person (God knows whom !) that recommend- 
ed him to take mercurial pills, w^hich he continued 
to take off and on for six months, omitting them 
whenever he became salivated. The ulcer never 
healed during this long period, but at length feeling 
himself getting daily weaker, and affected at night 
by profuse perspirations and pains of his limbs, he 
was induced to apply for admission into the Rich- 
mond Hospital. 

I ordered for him decoction of sarsaparilla and a 
pill containing three grains of the powdered leaves 
of cicuta, thrice a day ; the ulcer of the penis was 
dressed morning and evening with lint dipped in 
equal parts of balsam copaivse and olive oil, with 
the view of promoting the separation of the sloughs, 
which covered the greater part of its surface. The 



254 PHAGEDENIC VENEREAL DISEASE. 

ulcer of the lip, which was exceedingly irritable, 
was covered with a poultice of bread and water. % 
November 27th. — The ulcer of the penis was ex- 
tending, and had become more painful ; that of the 
lip stationary. The pills of cicuta were repeated 
with the addition of a grain and a half of the watery 
extract of opium to each pill. In other respects he 
was desired to go on as before. 

30th. — The appearance of the ulcer more favour- 
able — pain abated. 

Dec. 6th. — The ulcers of the penis and lip much 
improved, the former only painful when irritated 
by the passage of urine. 

Pulv. Ipecac. Comp. gr. xii. o. n. — Decoct. Sar- 
sap. — Omitt Pilulse ex Cicuta et Opio. 

18th. — The ulcer of the lip healed — that of the 
penis looking healthy was dressed with simple 
ointment — the crusts were gradually falling off 
from the spots on his skin, leaving red marks, 
and his general appearance had improved. He was 
however detained in the hospital until his general 
health was restored, and was discharged well on 
the 15th of January following. 

Case 43. — Thomas 3Iaher, aged 26, admitted 
20th January, 1824, on account of a small irritable 
ulcer, covered with white adhesive matter, situated 
at the orifice of the urethra — an ulcerated bubo on 
the right groin — a deep excavated ulcer on each 
tonsil — another, half-covered with a thick crust, on 
the skin of the left eye-lid and superciliary arch, 
and a large foul ulcer nearly the size of the palm of 
the hand, with a phagedenic margin, was situated 



PHAGEDENIC VENEREAL DISEASE. 255 

on the side of each of his legs. He exhibited a 
pale squalid countenance and an emaciated frame. 

Three months before his admission he had per- 
ceived the ulcer on the penis ; for this he took mer- 
cury extensively, and while under its influence the 
other symptoms detailed made their appearance. 

He was now ordered decoction of sarsaparilla, 
ten grains of Dover's powder at night, and the fre- 
quent use of fumigations of the sulphuret of mercu- 
ry to the ulcers of his throat. Those of his legs 
were poulticed. 

23d. — The ulcers were extending ; he was order- 
ed, in addition to his other medicines, five grains of 
the Ext. of Cicuta every sixth hour. 

Feb. 10th. The ulcers were granulating and look- 
ing healthy, and on the first of April he was dis- 
charged the hospital well. 

The following case is given for the purpose of ex- 
emplifying the usual fatal termination of venereal 
ulceration of the larynx. 

Case 44. — Terence Clarke was admitted July 
31st, 1815, into the Richmond Hospital. The en- 
tire pharynx, as far as could be seen, was engaged 
in an extensive ulceration, which had destroyed the 
uvula and a great portion of the velum. If the fol- 
lowing account, which he gave of his complaints be 
credited, the warmest advocates for mercury must 
allow that the remedy had at least an ample trial. 
He stated that four years previous to his applica- 
tion to me, he had a large ulcer on the prepuce, 



•256 PHAGEDENIC VENEKEAL DISEASE. 

which healed with difficulty under a full course of 
mercury of two months duration ; that eight months 
afterwards, his throat became affected, and nodes, 
which ulcerated, appeared on his shins; that for 
these complaints he was admitted into the Lock 
Hospital in the winter of 1813, where he remained 
twent3'-one weeks, and underwent two protracted 
and sev ere courses of mercury, but without any de- 
cided results, as his throat was ulcerated at the 
time he was discharged. 

That after he left the hospital his throat at first 
improved, but a few months afterwards becoming 
as bad as before, he was re-admitted into the same 
hospital. On this occasion he fell under the care 
of different surgeons, who put him under a course 
of mercury again; but which rendering his com- 
plaints worse, was very properly discontinued, and 
sarsaparilla directed, under the use of which the ul- 
cer healed, and he was discharged a second time, 
after remaining in the hospital fourteen weeks ; that 
scarcely two months after his discharge his throat 
again became ulcerated, he was admitted a third 
time into the same hospital, under the care of a 
third surgeon, who probably not regarding the for- 
mer failures of the specific^ doomed him to undergo 
another severe course of fourteen weeks duration, 
which a naturally robust constitution enabled him 
to endure, and that he was discharged the hospital 
in July, 1814, the ulcer of his throat remaining 
nearly in the same state as at his admission ; finally, 
he stated that the ulcer afterwards spontaneously 
healed, and that it occasionally ulcerated and heal- 



PHAGEDENIC VENEREAL DISEASE. 257 

ed of itself, but becoming more obstinate, he was 
induced again to seek admission into a hospital 
under my care. 

At this time his swallowing was extremely diffi- 
cult. I judge that the ulcer extended a consider- 
able way down the oesophagus, as he complained of 
severe pain extending from the lar3mx as far as the 
sternum. He could only swallow liquids, and the 
greater part of these regurgitated into the nares. 
Although in similar cases, I had immediately check- 
ed the progress of the ulcer by mercurial fumiga- 
tions, and the internal use of that medicine, yet its 
failure in the many trials to which this patient had 
been subjected, induced me to recur to other mea- 
sures. As I had sjeen similar ulcers which resisted 
mercury, give way to nitrous acid, I determined to 
tr}^ that medicine, diluted to such a degree as would 
enable him to swallow it. I also directed that the 
ulcer should .be touched thrice or four times daily 
with the oxymel seruginis, and that a seton should 
be inserted in his neck. Under this plan amend- 
ment immediately followed, and this extensive ul- 
cer as far as it could be seen, was healed before the 
9th of September ; but his voice had assumed that 
whispering sound which denotes an affection of the 
larynx, and the bones of his nose had evidently be- 
come affected, for there was an offensive discharge 
through the nares, along with which several small 
pieces of bone had come away. Under these cir- 
cumstances I deemed it warrantable to make a trial 
of the internal exhibition of the muriate of mercury 
conjoined with sarsaparilla, but it was not produc- 

2k 



258 PHAGEDENIC VENEREAL DISEASE. 

tive of any beneficial change ; it was therefore, after 
a trial of three weeks, discontinued for a pill con- 
taining half a grain of calomel with five grains of 
extract of cicuta thrice a day. But this was as un- 
availing as the former, for the discharge from his 
nose became more offensive, and more bony exfo- 
liations came away. His breathing became quick 
and evidently impeded ; he complained of pain in 
the larynx, expectorated a great quantity of slimy 
matter — had a teasing incessant cough — his coun- 
tenance betrayed great anxiety, and his pulse was 
from 110 to 120 — at the same time also his throat 
again began to shew signs of ulceration, and two 
scabby spots appeared, one on the left ala nasi, and 
the other on the chin. Under these circumstances, 
about the middle of October I discontinued the 
mercury, and put him on the compound decoction 
of sarsaparilla. Counter-irritation by means of blis- 
ters was kept up for some time on the exterior la- 
rynx, which he always pointed out as the chief seat 
of his distress, and irritation was lessened by opiates. 
If the larynx had not been affected, in all proba- 
bility he would have recovered under the use of 
sarsaparilla ; for the foul discharge and exfoliation 
from the nostrils ceased, the ulcer of his throat heal- 
ed, as did also the scabby ulcer under his nose and 
chin, the process beginning from the centre of each, 
a circumstance which marked the phagedenic na- 
ture of his disease. But while these favourable 
circumstances were going forward, cough, dyspnoea, 
increased expectoration, hectic fever, emaciation, 
and (Edema of the legs gradually set in, and evi- 



phaged?:nic venereal disease. 259 

dently evinced that he was affected with incurable 
phthisis. He lingered, however, till the 15th of Sep- 
tember, 1816. 

I had not an opportunity of examining the body 
afterwards, but I have been present at the exami- 
nation of several cases precisely similar, in which 
the cartilages and other parts were extensively de- 
stroyed by the effects of ulceration. 

Cases exemplifying the plan of treatment recom- 
mended where the nares are affected. 

Case 45. — Peter Murtough, admitted June 7th, 
1816. A large ulcer with undermined edges, was 
situated on the right tibia — foul discharge from the 
nares, and ulceration appeared on the vomer. He 
also complained of severe pain in one of his knees. 

He stated that a year before, he had an ulcer on 
the penis, the cicatrix of which, on examination, 
was found to be extensive. For this he underwent 
three courses of mercury, by each of which he was 
severely salivated. The ulcer on the leg appeared 
from its undermined edges, and burrowing disposi- 
tion, to resemble those which I had observed to 
arise from, the large species of tubercle, and which 
in most instances, yielded to the use of nitrous acid. 
I therefore directed that medicine in the present 
instance; under the exhibition of which his com- 
plaints steadil}^ and progressively amended, and he 
was discharged well on the 22d of July, 1816. 

Case 46.— John Martin, admitted May 6th, 1818 : 
Extensive ulceration of the fauces — the velum and 



260 PHAGEDENIC VENEREAL DISEASE. 

uvula were already destroyed — the ulcer was creep- 
ing forwards on the palate, and both tonsils, as well 
as the posterior pharynx as far as could be seen, 
were in an ulcerated state. The cartilage of his 
nose was sunk inwards — his voice was nasal — there 
was an offensive discharge from the nostrils, with 
occasional exfoliation of small pieces of bone, and 
he had profuse ptyalism, probably owing to the ir- 
ritation of the ulcer of his throat. The pupils of 
the hospital who accompanied me through the 
wards, on the day of this man's admission, will re- 
collect (as the case was of recent occurrence)* that 
on examining his throat, I stated my belief that the 
disease originated from a primary phagedenic ulcer, 
and that such an opinion would be strengthened, if 
we found an extensive cicatrix on the penis, or con- 
siderable loss of its substance. On examination, 
we found that the entire penis had been destroyed, 
and the history of the case strongly confirmed the 
opinion I had given of the nature of his disease. 

When we have any doubts on this subject, an atr 
tention to the cicatrix of the primary ulcer will as- 
sist our diagnosis ; for true chancre, and the other 
species of primary ulcers, except ivhere injiarmna' 
Hon and gangrene have bee?i excited, seldom cause 
any very extensive cicatrix, and the loss of sub- 
stance, if any, is inconsiderable. The history he 
gave of his complaints is briefly as follows. 

Nineteen months previous to this period, he had 

* This case is re-published verbatim from my work on the 
Symptoms and Specific Distinctions of Venereal Diseases, pub- 
lished in 1818= 



PHAGEDENIC VENEREAL DISEASE. 261 

an ulcer on the prepuce, for which he was admitted 
into Stephens's hospital, where he was put on a 
course of mercurial friction, but as soon as he be- 
came salivated, the ulcer began to spread. That 
medicine was therefore discontinued for a time, but 
as soon as his mouth was well, it was again renew- 
ed, and he was put through a smart mercurial 
course, during which the ulcer gradually gained 
ground, until it destroyed the entire penis, and then 
its ravages ceased, and it began to heal. When the 
mercury was laid aside, he was successively order- 
ed sarsaparilla, cicuta, and nitrous acid. About the 
beginning of the present year (1818) the ulcer of 
his throat appeared. He was altogether eighteen 
months in the hospital alluded to, and left it with 
the view of going to the country, three weeks be- 
fore his admission into the Richmond hospital. 

1 ordered for him the antimonial solution, con- 
joined with the decoction of sarsaparilla, thrice a 
day, and directed that the entire ulcer should be 
touched morning and evening with the oxymel 
seruginis. 

On the 11th, the ptyalism had ceased, and his 
swallowing was improved. The antimonial solu- 
tion was discontinued for a drachm of powdered 
sarsaparilla thrice a day. 19th. There was a per- 
ceptible amendment in the ulcer, and on the 29th, 
it was rapidly healing. 

June 8th. — The entire ulcer was healed, except 
two or three spots the size of a pea, which was co- 
vered with yellow adhesive matter ; these spots 
were touched frequently with a solution of nitrate 



262 PHAGEDENIC VENEREAL DISEASE. 

of silver, in the proportion of three grains to an 
ounce. The oxymel jeruginis was discontinued. 

22d. — Only one ulcerated spot the size of a pea 
remained : the offensive dischar2;e from the nose had 
totally ceased. 

26th. — His throat was completely well, and hav- 
ing no complaints, he was anxious to leave the hos- 
pital, but by my desire he remained another week, 
and was discharged on the 2d of July. 

Case 47. — Thomas Farrell, admitted 31arch 10th, 
1814, was affected with soreness and enlargement 
of the ossa nasi, a ])urulent discharge from the nos- 
trils, and a separation and sinking of the cartilage of 
the nose. An extensive granulating: sore with rais- 
ed edges, and surrounded by discoloured integu- 
ments, was situated on his right arm; and on the 
lower part of the left tibia there was a large node. 
He complained of pains in his head, knees, and 
shoulders, and difficulty of swallowing. On exami- 
nation, I found the phan;-nx raw and inflamed, but 
there was not any appearance of ulceration. 

He stated that he was near two years disorder- 
ed -. the first symptom was an ulcer on the prepuce, 
which healed under the internal use of the muriate 
of mercuf}'. The next symptoms that occurred 
were ulcers under his knee, and an eruption on his 
body, which disappeared also under the use of mer- 
curv, but asrain recurred. The node and affection 
of his nose appeared three months before his ad- 
mission, and from the commencement of the disease, 
he was constantlv usins; mercurv under the direc- 
tion of different surgeons ; almost every one of 
whom subjected him to mercurial frictions. 



PHAGEDENIC VENEREAL DISEASE. 263 

I directed him to take fifteen grains of the com- 
pound powder of ipecacuanha, morning and even- 
ing, and the decoction of sarsaparilla ; but on the 
34th, none of his symptoms being relieved, I order- 
ed him to discontinue the powders, and to take the 
solution of muriate of mercury with the decoction. 

22d. — The pain of his head was alleviated ; that 
of his knees and shoulders completely removed; 
and he was in every respect better. He continued 
the same plan as long as he remained in the hospi- 
tal, from whence he was discharged well on the 
1 1th of April. 

I have not among the preceding cases detailed 
any instance of the good effects of fumigating the 
nares with mercurial preparations, as recommend- 
ed for venereal ulcerations of this part, for it so 
happened, that there were not any cases noted in 
which this measure was employed. 

In almost every instance of the constitutional 
symptoms of the phagedenic disease detailed, mer- 
cury had been previously employed, and under 
every consideration of the circumstance, to an un- 
warrantable extent. The early use of this remedy as 
has been stated, not only rendered the disease more 
difficult of cure, but more liable to relapse after the 
patient had apparently recovered. So that a just 
estimate can scarcely be formed of the benefits of 
the plan of treatment recommended in the cases I 
have adduced. For so general is the employment 
of mercury in this, as well as in every other spe- 
cies of venereal complaint, that it is but seldom we 



264 PHAGEDENIC TE>"EREL\L DISEASE. 

meet with an instance in which it has not been ex- 
hibited. If, however, we are fortunate enough to 
light upon a case in which the use of mercurv has 
not been adopted, we find the disease less compli- 
cated, less tedious, more uniform in its symptoms, 
and by far more easily cured. 

Affections of the bones of the nose I have found 
to o<:cur in several instances, while the primary 
symptoms, an ulcer of the phagedenic species, was 
still present, and I am inclined to believe that this 
common, but most dreaded effect of a venereal vi- 
rus, is the characteristic constitutional symptom of 
the ulcers under consideration. 

It was with no small decree of satisfaction that I 
perused 3Ir. Ferguson's •• Observations on the Ve- 
Bereal Disease in Portugal, as affecting the British 
soldiery and natives,"^ published in 1813; as I con- 
ceive his statement of the progress of the symp- 
toms, and the manner in which they were affected 
by mercury, together with the treatment found 
most applicable, strengthen the opinions I have of- 
fered on the nature of the phagedenic and slough- 
ing ulcers. "Tis true, he no where designates the 
primary venereal ulcers of Portugal by these terms ; 
Qor could it be expected that he should, as he evi- 
dently seems to be of the general opinion, that all 
venereal maladies spring from one common poison, 
the syphilitic. But I am inclined to believe, that 
the phagedenic and sloughing ulcers are far more 
general in Portugal than in these countries; and 

* See Medito-Chinirsical Transactions, Vol. IV. 



PHAGEDENIC VENERE.^L DISEASE. 265 

that their constitutional symptoms were actually 
the subject of Mr. Ferguson's observations. I 
ground my opinion on the following reasons, chiefly 
deduced from his own paper. The frequent me- 
lancholy mutilations which occurred among our sol- 
diers, could only have arisen from the ravages of 
the phagedenic and sloughing ulcers ; and not from 
the slow progress of a true syphilitic chancre, which 
would not probably have been checked by the mer- 
cury, which at this period was, in every instance of 
venereal infection, recurred to by the surgeons of 
our army. Besides the name which the venereal 
disease in Portugal acquired among the British sol- 
diery, the Biack'Pox, reminds us of the most re- 
markable character of the sloughing ulcer. In the 
next place, the appearance of secondary symptoms, 
while the patient was strongly under the influence 
of mercury ; and lastly, the manner in which the 
disease was treated by the native practitioners; 
viz. by local applications, decoctions of the woods, 
and the exhibition of an insignificant quantity of 
mercury, when the disease attacked the bones. 

Mr. Ferguson, after stating a variety of interest- 
ing particulars of the venereal disease of Portugal, 
which one and all reminded me of the symptoms 
and progress of the phagedenic and sloughing ul- 
cers, comes to the following conclusion, which 
equally applies to those maladies as known in this 
country. - 

1. " That the disease, in its primary state, is cu- 
rable in Portugal without mercury. 

2. " That the antisyphilitic woods, combined with 

2l 



266 PHAGEDENIC VENEREAL DISEASE. 

sudorifics, are an adequate remedy for coDstitutioii' 
al symptoms; the quantity of mercury being al- 
wajs insignificant and often altogether omitted ; or^ 

3. " That the virulence of the disease has become 
so much mitigated by reason of general and in- 
adequatel}' resisted diffusion, or other causes, that, 
after running a certain (commonly a mild) course, 
through the respective orders of parts, according 
to the known laws of its progress, it exhausts itself, 
and ceases spontaneouslj'." 

As to his last deduction, we have to regret, that 
the constant interruption to the progress of the dis- 
ease, by means of mercury, has, in these countries, 
prevented us from witnessing the gradual decline 
and exhaustion of the virus, as it seems is the case 
among the natives of Portugal : and there are strong 
grounds for believing, that the ravages which the 
venereal disease of that country committed on the 
British troops, arose not so much from the inflam- 
matory disposition manifested in the constitution of 
the inhabitants of colder climates, on their arrival in 
a warmer, as from the indiscreet exhibition of mer- 
cury : a medicine from which Mr. Ferguson informs 
us, the " native practitioners religiously abstain, 
considering it with horror, as one of the poisons 
which foreigners madly wield/' 

Among several instances which came under my 
observation of the mali2;nitv of the venereal disease 
of Portugal, and the inadequacy of mercury for its 
removal, the following was the most remarkable : 

Case 48.— On the 9th of April, 1814, 1 was consult- 
ed by a young oiSicer, who three years before had 



PHAGEDENIC VENEREAL DISEASE. 267 

received a venereal complaint in Lisbon, which had 
produced the following catalogue of melancholy 
mutilations. The septum, alse, and cartilage of his 
nose had been destroyed by ulceration, leaving a 
wide extended opening into the nares. It had 
ceased to extend, and was nearly healed, but it still 
produced an offensive discharge. There was also 
an ulcer of the left leg, extending from the ham to 
the heel ; the upper part was granulating, the low- 
er foul and phagedenic : the calf of his leg had beeu 
entirely destroyed by the ulcer ; and his leg was 
contracted into a permanent semiflex position. 

He stated that the first symptom of his disorder 
was an ulcer, which, on examination, I found had 
destroyed the glans, and great part of the body of 
the penis. For this complaint, the surgeon of his 
regiment put him on a course of mercury, which he 
stated was of no service to his complaints; and that 
the ulcer extended rapidly, and by sloughs, under 
its influence ; — that in a few months afterwards an 
eruption of what he described as pustules, appear- 
ed on his back — the ulcer of his leg followed, hard 
bumps rose on his cranium, and the bones of his 
nose became affected — that the ulcer of the penis 
healed and the bumps on the cranium disappeared 
under the use of nitrous acid — that he afterwards 
came to England, where he remained near two 
years, and underwent several severe courses of 
mercury by inunction. In short, that from the com- 
mencement of his disease, to the period of his ap- 
plication to me, he was under the almost incessant 
action of that medicine. His 2;ums were all de- 



268 



PHAGEDENIC VENEREAL DISEASE. 



*stroyed by the rep' ated salivations he ha-d under- 
gone ; and he was at the time he applied to me un- 
der its influence. 

A stronger instance than this, of the inefficacy 
and injurious consequences of mercury cannot be 
adduced. I sent him to the countrv, where his fa- 
niily resided, with little else than directions respect- 
ing his diet ; to abstain from mercurv' ; and to take 
the compound decoction of sarsaparilla and antimo- 
iiials. Some time afterwards I heard that his health 
had considerably improved, but I never had the sa- 
tisfaction of ascertaining whether his recovery was 
completed. 

When my first edition appeared, so many daring 
and novel doctrines, contrary to the received opi- 
nions of the day, drew upon me, of course, the 
severest animadversions of my contemporaries. 
These I was prepared to meet in silence, until time 
should bring to the test the views I submitted to 
the public. A critic, however, appeared shortly af- 
ter the publication, in the Edinburgh Medical and 
Surgical Journal, for July, 1815, written with so 
much asperity and unfairness, that I felt myself 
called upon to relinquish my intended silence ; not 
so much with the view of replying to my Review- 
er's objections, which consisted chiefly of idle and 
dogmatical assertions, without proof or foundation, 
as to set the public right with respect to passages 
garbled or intentionally misunderstood and misre- 
presented. From the general tenor of the paper 
in question, I suspected the quarter from whence 
it came, and the object for which it was written. 



PI^AGEDENIC VENEREAL DISEASE. 269 

These suspicions have been since fully confirmed ; 
and I am, probably, better acquainted than the Edi- 
tor of the Review himself, with the persons who 
were enojaged in the production of an article, which, 
to say the least of it, certainly did not add to the 
character of that most respectable Journal. 

From my own personal knowledge of the Editor, 
as well as the character he bears with the world, I am 
certain that he would never intentionally make his 
Journal the vehicle of a rancorous attack upon any 
individual, for the purpose of maintaining another 
in the elevated situation in which his opinions (at 
that time generally received with respect to vene- 
real complaints) had placed him, and which that 
other must have regarded as a despicable tissue of 
acrimony, delusion, and sycophancy. But I shall 
merely refer to my Reply, which appeared in the 
same Journal for October, 1815, and shall leave the 
critic without further notice, as an additional re- 
cord to the many which already exist, of the usual 
means to which interested and prejudiced indivi- 
duals resort to oppose the progress of truth. I 
shall occupy the time of my reader much better, 
by a consideration of the fair, manly, and scrutiniz- 
ing observations of Mr. Guthrie, who sees with the 
skilful eye of an experienced veteran, the weaker 
points of his opponent, and fairly grapples with the 
subject without changing its nature in order to in- 
sure an easy victory over an enemy of his own 
creation.'* In replying to Mr. Guthrie's objections, 

* Mr. Guthrie's " Observations, &c." have been republished in 
America; for which, see Eclectic Repertory, vol. viii. p. 321. 



270 PHAGEDEMC VENEREAL DISEASE. 

I conceive that I answer all that has been urged of 
any weight against the opinions I espouse ; I can- 
not, however, enter into an examination of his re- 
marks, without first testifying my sense of the can- 
did, polite and creditable manner in which he has 
discussed the subject, the gratification I feel, that 
the particulars are so few in which we differ from 
each other, and my regret that there is a point, 
however unimportant, in which we are not agreed. 
But it is satisfactory to find that his objections do 
not lie against the practice I recommend, but almost 
exclusively against the doctrine of the plurality of 
venereal poisons, which I have been led by the 
strongest reasons to adopt. 

But convinced as I am, by a vast multiplicity of 
evidence, of the truth of this opinion, yet so little do 
I value it in comparison of the practical results to 
which it led me, that throughout my work, I advert- 
ed but little to this part of my subject, and confined 
myself altogether to points of practice, except so 
far as it was necessary to the explanation of my 
mode of discriminating the dangerous and malig- 
nant species of venereal diseases from the more 
mild and manageable. Indeed, my most strenuous 
endeavours, and I thought they could scarcely be 
mistaken, were directed to convince surgeons of 
the necessity of paying more attention than was cus- 
tomary, to the distinctive characters and appear- 
ances of both primary and constitutional symptoms 
in venereal complaints. 

I had satisfied myself that our diagnosis and mode 
of treatment ought to be regulated in a great mea- 



THAGEDENIC VENEREAL DISEASE. 271 

sure by those very characters and appearances, no 
matter whether we consider them as arising from 
one poison, or from many, or whether they are ow- 
ing to peculiarities of constitution, or to those causes 
assigned by Mr. Guthrie, in his " Remarks," when 
he says, " I am, then, for the present, disposed to 
refrain from believing in a plurality of morbid poi- 
sons, each invariably producing a disease of one 
distinct character, or of one specific poison modified 
by the powers of the constitution, or of the part ; 
but rather to place reliance in the combined opinion 
of different morbid poisons {to use the common term) 
being generated^ in different people, and stages and 
states of the disease, wider circumstances which I 
no more understand than others do of the nature of 
the syphilitic poison itself'' 

Whether the views of this enlightened surgeon 
will serve to remove the obscurity with which this 
perplexing subject is enveloped, and better explain 
than any thing hitherto offered, the numerous symp- 
toms and appearances which venereal complaints 
display, I leave to the judgment of the reader, and 
shall altogether refrain from making any observa- 
tions upon them. But, in truth, the question will 
scarcely be allowed to be decided, until the institu- 
tion of an enlarged scale of experiments by inocu- 
lation ; which, as I have observed in my last Essay,* 
" it is not to be expected any man will be so public 
spirited as to submit to himself, or so unreasonable 
as to inflict upon others." The utility of experi- 

* " Observations on the Symptoms and Specific Distinctions of 
the Venereal Disease." 1818. 



•>7*> 



PHAGEDENIC VExXEREAL DISEASE, 



ments by inoculation has, since this observation was 
made, been sufficiently proved by those instituted 
by Mr. Evans, and referred to in my third chapter. 
My reasons for espousing the opinion of a pluralit}^ 
of venereal poisons are given at large in my first 
chapter, which it would be unpardonable here to 
repeat. 

In my publication I have detailed a number of 
cases of the primary phagedenic ulcer, which were 
all attended (two cases excepted) with a similar 
eruption ; viz. bj^ tubercles, or spots of a pustular 
tendency, which degenerated into obstinate ulcers. 
In the two exceptions alluded to, the eruption was 
papular; and I am inclined to conjecture that the 
primary ulcers from which it arose, were not origi- 
nally phagedenic, but became so through irritation 
or improper management. 

From various passages in Mr. Guthrie's remarks, 
1 collect, that he is of opinion that there is no such 
ulcer as a primary venereal phagedena ; and that all 
ulcers of this description are originally mild, and 
become afterwards phagedenic, through causes with 
which we are at present unacquainted. But once 
they become phagedenic, he believes they affect 
the constitution in such a way as to produce the 
train of constitutional symptoms I have described 
as appertaining to the phagedenic venereal ulcer. 
I trust this is a faithful though concise account of 
his opinions, as it would render this paper too long 
to transcribe the passages from which I collect it. 

In support of his views and in opposition to mine, 
Mr. Guthrie, in the first place, assures us that he 



PHAGEDENIC VENEREAL DISEASJ;:. 2?3 

has frequently seen those constitutional symptonii? 
which I had attributed to the phagedenic p^:"imary 
ulcer, succeeding primary ulcers which were prigi? 
nally of a mild nature, and which afterwards became 
phagedenic; and in the next he argues, that the 
slowness of the progress of the ulcer in many of the 
cases which I have detailed, sufficiently evinces that; 
they could not in their origin have been phagedenic. 

Against Mr. Guthrie's own experience I can havQ 
nothing to object, and the point niust remain at i$r 
sue between us, to be determil^ed by future ojjserr 
vations; but I cannot admit the accuracy of his 
views, when he describes the phag^d^nic ulcer as 
always necessarily rapid in its progress, for I can 
aver, (and I am confident that I am not singulfir in 
this respect,) that I have frequently witnessed the 
existence of this ulcer during four, six, or eight 
nionths, or even longer, creeping slowly from one 
part to another, alternately healing and ulcerating, 
and leaving deep furrows, yet without destroying^ 
as it mor^ usually does, the parts ij: attacks. Ano- 
malous, therefore, a§ it appears, we may readily 
conceive why the opera dancer at Lisbpn, ipentipiir 
ed by Dr. Ferguson, should infect many pf her par^? 
mours with a malignant disease, without being her^ 
self under the necessity of discontinuing the public 
practice of her professipn. 

" Ref)erring to my first edition," Mr. Guthrie obr 
serves, " we have a sketch of the progress of the 
phagedenic ulcer ; but we (Jo not find any descrip- 
tion of that ulcer from the commencement of ulcera- 
ted absorption, as we do of the slougjiing ulcer from 

2 M 



2v74 PHAGEDENIC VENEREAL DISEASE. 

the commencement of the sloughing process. Nei- 
ther is one given in the second book ; so that we 
are left in doubt whether his specific phagedena 
begins as such, or whether it assumes that charac- 
ter after a certain lapse of time. If the former be 
the fact, it adds strength to my objections to his 
cases ; if the latter, it is necessary we should be in- 
formed of the precise period required for the spe- 
cific character to show itself." In answer to this 
Qbservation, I must acknowledge that it has not 
been my good fortune to see a phagedenic ulcer at 
an earlier period than perhaps the second or third 
week after its commencement, and therefore I can- 
not aver, from my own experience, whether it pre- 
sents the precise phagedenic character ab initio'^ 
But I have happened to witness in one instance, the 
very commencement of the sloughing ulcer, the par- 
ticulars of which are reprinted in Case 21, of this 
edition, and are alluded to by Mr. Guthrie in his 
Remarks. 

The gentleman affected with it, who was an inti- 
mate friend, shewed it to me a few minutes after 
his own attention had been solicited to the part ; 
and at this time it exhibited the appearance of a 
black mortified speck, not larger than a grain of 
shot From this small beginning, it went on, alter- 
nately sloughing and ulcerating with a phagedenic 
edge, until it destroyed the greater part of the pre- 
puce and a portion of the glans. 

After it had existed a few days, it did not differ 

* See the commencement of the 5th chapter, where the char- 
acters of the phagedenic ulcer are considered. 



PHAGEDENIC VENEREAL DISEASE, 275 

in appearance from the nunrerous advanced slough- 
iiag ulcers I had seen and treated in the wards of 
the Dublin Lock Hospital ; so that I think Mr. Gu- 
thrie must have been under some misapprehension, 
when he made the following observation: — "I ho- 
nestly declare, I cannot recollect more than two 
cases any way resembling it having occurred to me, 
out of several thousand instances ; I do not be- 
lieve that the proportion of such cases is greater 
than one in five thousand." — Mr. G., in making this 
observation, must mean to confine himself to the 
commencement of the ulcer ; and I do not marvel 
he has seen but two instances — I have seen but one ; 
and I scarcely expect to see another, as it excites 
so little sensation, not to say pain, at this stage, 
that it may even escape the observation of the pa- 
tient himself 

It seems Mr. Guthrie and I are agreed w^ith re- 
spect to the treatment of the phagedenic ulcer, and 
of the formidable train of secondary symptoms I 
have stated to arise from it ; and he even refers to 
cases (See p. 329 and 330 of his remarks) in which 
he witnessed the primary phagedenic ulcer and its 
secondary symptoms, as I have described them, both 
existing together in the same patients. But he con- 
ceives I am v/rong in attributing these secondar}'' 
symptoms exclusively to the phagedenic primary 
ulcer. His words are, " I can bring dozens of well 
substantiated cases, in which the ulcers were at 
first without any sloughing and phagedenic charac- 
ters for a considerable time, yet subsequently assum- 
ed them, a7id tvere foUoived by the secondcu^y symp- 



27^ 



PHAGEDENIC VENEREAL DISEASE. 



toms which Mr. C, considers as the true constitutioh' 
al ones of specific venereal phagedena^ 

It would be presumption in tne td maintain, that 
Ihe constitutional symptoms I have detailed as ap- 
pieirtaining to thie phagedenic ulcer, can never ari^e 
from any dther form Of primary ulcer ; all that I 
have stated is the fruit of niy experience, and that 
enables me to affirm, that in every instance in which 
I had an opportunity of tracing the constitutional 
Symptbnls in question to their primary ulcer, that 
tllcet always exhibited the phagedenic character — 
Mr. Guthrie brings forward his own experience in 
isupport of the contrary opinion ; but acknowledges 
that thfe ulcers he refers to aftei'wards became pha- 
gedenic. I give him full credit for his assertions, 
arid am certain the investigation of this intricate 
subject cannot be in better hands. But it is proba- 
ble th^fe is less difference of opihion ori this head 
belwieen us theri hie is inclined to imagine. He will, 
at lieast, do nle the justice to allow that my cases 
are detailed with candour, since he has found in 
them Wherewithal to assail the very opinions I 
grounded upon them ; for so far from arranging them 
i'n support of a preconceived theory, I made no at- 
tempts at generalization until the cases were com- 
pleted, and the circumstances they contained were 
carefully examined and compared with each other. 
But so solicitous was I in noting those cases, that 
if I entertained any doubts with respect to the na- 
ture of an ulcer, I endeavoured to convey my own 
uncertainty in the language in which I described it. 
Thus, in niy last Essay, in Cases 28, 29, and 32, the 



PHAGEDENIC VENEREAL DISEASE. 277 

primary ulcers, which were followed by the phage- 
denic constitutional symptoms, are cautiously de- 
scribed in the following words : — Tlue first is " a small 
ulcer of foul appearance and phagedenic character^ 
on one of the labia." The second, " a small foul 
ulcer inclining to phagedena. — The third, an ulcer 
about the size of a sixpence, exhibiting a white 
sloughy appearance, was situated on the body of 
the penis ; the integuments of which were under- 
mined to sotiie little extent." 

Id all the other cases, where iio doubt could exist 
with respect to the nature 6f th^ ulcer, it was, 
witht)ut circumlocution, termed a phagedenic ulcer. 
The doubtful ulcers were, I well i^collectj covered 
with a white tenacious adherent matter ; and after a 
time, evinced a disposition to burroiv, with a phage- 
denic border, which, together with the constitutional 
symptoms that attend them, induced me to class 
them with the phagedenic. Perhaps, indeed, I was 
guilty of some remissness in not pointing my read- 
er's attention to the language I employed in those 
different descriptions. 

Under these circumstances, it is not improbable 
but that the cases which came under Mr. Guthrie's 
observation were of this nature ; and it would be 
highly advantageous if he, as well as all future en- 
quirers, would attend particularly to the characters 
of such primary ulcers as are followed by the con- 
stitutional symptoms, which I have, without circum- 
locution, termed phagedenic. It has been denied, 
that these constitutional symptoms exclusively ori- 
ginate from a phagedenic ulcer, but whatever may 



278 PHAGEDENIC VENEREAL DISEASE. 

be the primary ulcer from which they arise, they 
indicate to the practitioner the most obstinate and 
dangerous of venereal diseases — one in which full 
courses of mercury are most decidedly injurious j 
but which is often benefited by the alterative plan : 
but even this I would postpone (except the safety 
of some important part was threatened) until the 
disease was evidently on the icane. 

A few other objections still remain to be answ er- 
ed. Mr. G. observes, " In the first work we find, 
that the tubercular eruption is considered as a dis- 
tinct constitutional symptom, and arranged as the 
fourth in order, and he was then disposed to attri- 
bute it to the burrowing ulcer. In the second work 
we find he distinctly classes the pustular and tuber- 
cular eruptions under one head, and refers them to 
the phagedenic and sloughing ulcer." My answer 
to this is very simple, and may be very brief. My 
experience was not stationary and opportunities oc- 
curred of seeing pustules and tubercles in the very 
same patients, who were a,frected with primary 
phagedenic ulcers ; add to this, that I had sufficient 
reason to consider the burrowing and phagedenic 
ulcers as the same species of complaint, because 
these ulcerations are very similar, and they produce 
the same constitutional s3^mptoms. From another 
passage in the same page I collect, that Mr. G, con^ 
ceives I am guilty of the inconsistency of overturn- 
ing my own doctrine by the detail of cases of the 
spontaneous origin of tubercles in deranged consti- 
tutions, where there was no reason to suspect the 
communication of any morbid poison. 



PHAGEDENIC VENEREAL DISEASE. 279 

That tubercles which terminate in ulcers, are 
produced by morbid poisons, and that they also oc- 
cur simpiy in deranged constitutions, where no 
morbid poison has been imbibed, cannot, at pre- 
sent, be denied; though to account for the anomaly 
will not be so easy a task. But I do not see how I 
have overturned my own opinions ill detailing these 
facts — as well might it be argued, that buboes do 
not arise from a venereal poison, because they some- 
times originate in other causes. 

To his arguments in support of the same objec- 
tion, derived from an eruption both papular and 
pustular, existing at the same time, (p. 337 of Mr. 
G.'s Remarks) I answer that the eruption adverted 
to by Mr. G. consisted of ulcers covered with thick 
crusts and pustules intermingled with papulse. The 
character of the eruption was, however, obviously 
pustular, though papulae were present ; precisely in 
the same manner as the eruption in small-pox is 
pustular, though papulse may be intermingled with 
the full formed pustules. 

The case of sloughing ulcer, with constitutional 
ulcers, Avhich I stated in my first publication as 
healing from their margins, is also urged against 
me in the same page, in corroboration of the same 
objection. It is true, I have pointed out as one of 
the distinctive marks of the constitutional ulcers of 
the phagedenic disease, their healing from their 
centre, and not from their margins. A peculiar 
character, which I had so often observed in the se- 
condary ulcers that arise from a primary phage- 
dena, that I could not but resjard it as a mark of 



880 PHAGEDETNIC VENEREAL DISEASE. 

great practical importance, which designated an ob- 
stinate and dangerous disease ; but I did not, and 
do not affirm, that this mode of healing is exclusive- 
ly attendant upon the constitutional ulcers of a pri- 
mary phagedena. In that part of my work >vhich 
treats of the constitutional phagedenic ulcer, I have 
explained the cause of this mode of healing. From 
which we may infer, that although it occurs so often 
in this form of disease, as deservedly to be consi- 
dered a diagnostic character, yet it may not always 
be present, for the reasons there stated. My mean- 
ing is sufficiently evinced by the following passage 
in my Synopsis :— " Eruption of tubercles, or spots 
of a pustular tendency, or both intermixed, preced- 
ed by fever, and terminating in ulcers covered with 
thick crusts, which often assume a conical form, 
healing from their centre, and extending with a 
phagedenic margin." — But the primary ulcer, in the 
above instance, might have been originally of my 
second class — that with high edges, which ap- 
proaches to the phagedenic character, and have be- 
come sloughing through irritation; and if so, the 
constitutional ulcers would naturally heal from their 
margins. An enquiry of this kind should meet with 
that candid indulgence which its delicacy requires, 
while the strictest scrutiny need not be neglected. 
" The difference of opinion, (Mr. Guthrie, in con- 
cluding his remarks, observes,) which exists be- 
tween us, does not, I am happy to say, e:^tend to 
the mode of curing these complaints, except in one 
instance. In the antiphlogistic treatment of the 
pjiagedeni.c and common sloughing ulcer, I fully 



PHAGEDENIC VENEREAL DISEASE. 28 1 

coincide; it is the practice which Dr. Ferguson 
recommended before Mr. Carmichael wrote, and 
which I have for some years pursued. I concur 
with him in the necessity of abstaining from the use 
of mercury in the earlier stage of the constitutional 
symptoms, whilst I bear the strongest testimony to 
its great utility in the latter, when administered 
with caution. 

It is as gratifying to me as to Mr. Guthrie, that 
in the more material points — those of practice — 
we are agreed ; although he is disposed to give Dr. 
Ferguson all the credit of this coneurrence ; still, 
however, unwillingly, I must, in duty to myself, 
make some references to dates, which will be found 
below,* in order to prove that I have not endea- 
voured to appropriate to myself the discoveries of 
any man. 

The object of Dr. Ferguson's candid and excel- 

* The 4th vol. of the Medico-Chirurgical Transactions, in which 
Dr. Ferguson's mostinteresting paper is inserted, is dated Novem- 
ber 24, 1813, and it came to my hands early in 1814. The first 
part of my work was published in the beginning of January, 1814 j 
but cases are detailed of the successful employment of blood-let- 
ting, and the antiphJogistic means in painful ulcers attended with 
inflammation, which occurred so far back as 1811, 1812, and 1813. 
(See Cases 2, 3, 4, and 6, all of which were Hospital Cases, under 
the eye of many of the profession.) 

The Second Part of the same work begins with my 4th Chap- 
ter, and was published in the latter -end of 1814. In which it ap- 
pears that the same treatment, that I had found so useful in in- 
flammatory ulcers, I had also adopted in phagedenic ulcers, which 
are so generally painful and irritable ; and many of these cases so 
treated occurred in the Lock Hospital so far back as 1811, 1812, 
and 1813. See particularly Cases 48, 51, and 53. Many other 
cases to the same eifect, I detailed in ray public lectures on the 
■subject delivered at the Lock Hospital in the winters of 1812 and 

1313. 

«-^ 

2n 



282 PHAGEDENIC VENEREAL DISEASE. 

fent paper is to inform us of the practice among 
the Portuguese surgeons, aiid of the successful is- 
sue of their mods of treatment^ in which mercury is 
so little employed^ and not to detail any improve- 
ments emanating froin himself; and it was with no 
little satisfaction that, in thiB second part of my workj 
I was enabled to resort to his important testimony 
in support of my own views, at that time standing 
ffo much in nieed of such corroboration. 

Mr. Guthrie, I find, differs from me in one point 
bf practice — the use of the lancet in the slough- 
ing ulcer. This diffei^ence of opinion is, however, 
grounded, not on his experience, but, as appears 
from the passage, p. 339, (where he compares the 
sloughing ulcer to the gangrenous toes of old peo- 
ple) on theoretical views* The practice I have re- 
commended is supported by a sufficient experience 
^f its utility ; for these ulcers spread rapidly under 
the influence of wine and bark, yet cease their rava- 
ges ori the occurrence of a spontaneous hsembrrhage 
from the part, or from tlie use of the lancet, and the 
antiphlogistic plan combined with the exhibition of 
t)pium or cicuta. 

But, with respect to the existence of a pliirality 
t)f poisons, each of which produces primary and se- 
condary symptoms peculiar to itself, there are deci- 
sive facts to vindicate my adoption of this munh 
canvassed opinion, and they are these^^that ih each 
of the four classes, into Avhich I have divided vene- 
real diseases, I have witnessed the eruption, or 
other secondary symptoms, immediately succeed- 
ing the corresponding ulcer, or other primary s^p- 



PHAQEDENIC VENEREAL DISEASE. 283 

toms, or both existing in the same patient at ope 
and the same time ; and in no instance do I attempt 
to establish a class in which it is not supported on 
those solid foundations. It is true, in one of those 
classes (the Pustular Venereal Disease) I have not 
had the good fortune to witness this conjunction 
more than half a dozen times. But in all the other 
classes, the evidence which in this way confirms 
them, is amply sufficient, and I will add, in two of 
them superabundant. I trust therefore, that I have 
perfectly satisfied Mr. Guthrie, that his objections 
to my theory, if theory it can be called, which does 
not depend on speculation, but on indisputable facts, 
are 7iot sufficient to subvert it ; but even if these 
facts were annihilated it would be to me as it must 
be to others, a matter of comparative indifference, 
as long as the practice I have recommended shall 
be considered as of value. Yet, as a step to that 
practice, I must acknowledge my obligations to the 
views I connected with them, and which led me at 
once to the beneficial measure of rejecting the pre- 
vailing prejudice of the medical world, and with- 
holding the use of mercury in the generality of ve- 
nereal disorders. This mode of treatment, chiefly 
in consequence of its successful adoption in the ar- 
my, already prevails^© an extent that could scarce- 
ly, in so short a period, have been hoped for; and 
(to give it no other name) the theory which was of 
such advantage to my labours, may possibly be no 
longer of any considerable importance, unless, in- 
deed, it shall hereafter be discovered, that each pe- 
Guliar species of venereal complaint will admit of a 



284 PHAGEDENIC VENEREAL DISEASE. 

speedier cure by means of a remedy that is less effi- 
cacious in those of a different character. But this 
is now of little moment, since every species of ve- 
nereal disease can be combated by specified means, 
and with the fairest hopes of decisiv^e success. Let 
me not, however, be understood as admitting, that 
the classification I have introduced (if that classifi- 
cation is miscalled my theory, for theory I have 
none) having accomplished its purposes, may now 
be abandoned. Its utility must hereafter be as 
great as heretofore, in developing and explaining 
the circumstances of anomalous cases ; and may one 
day be a means of distinguishing those venereal dis- 
eases with which we are at present acquainted, 
from those that may be imported among us from 
abroad, or which may possibly originate from very 
different causes, not necessary here to investigate 
or conjecture. 

Without pluming myself, however, upon these 
considerations, I rest all my credit upon more sub- 
stantial grounds, the practice to which they gave 
birth ; and particularly the distinctive characters I 
have established for the more ready discrimination 
of malignant and destructive disorders from the 
milder and safer ; the appropriate remedies I have 
experienced as useful, and some of which I was the 
Ifirst to adopt, particularly those extensive depletions 
which are now found of so much benefit under cir- 
cumstances of inflammation ; the use of antimonial 
preparations in every form of venereal disease, the 
free exhibition of medicines of the narcotic tribe in 
painful phagedenic ulcers ; and, lastly, the simple 



PHAGEDENIC VENEREAL DISEASE,, 285 

and satisfactory criterion I have introduced into no- 
tice, by which it is ascertained when mercury may 
be employed with effect, and when it ought to be 
discarded as useless or pernicious. 



CHAPTER VI. 

SCALY VENEREAL DISEASE- 

The primary syphilitic ulcer, or that which gives 
origin to the scaly eruption, has been well described 
by Mr. Hunter in the following words : '^ The sore 
i^ somewhat of a circular form, excavated, without 
granulations, with matter adhering to the surface, 
and with a thickened edge and base. This hard- 
ness, or thickening, is very circumscribed ; not dif- 
fusing itself gradually and imperceptibly into the 
surrounding parts, but terminating rather abruptly.'* 

Every word of this description should be strictly 
attended to, as conveying an exact definition of 
chancre ; so far, at least as it occurs on the glans 
and prepuce, though not on the body of the penis, 
where a slight difference is observable. Ulcers 
which are not sj^philitic may, but seldom have a full- 
ness and slight induration round the circumfer^ 
ence ; but then, this induration does not convey that 
sensation of solidity and firmness to the touch 
which that of a real chancre possesses, neither does 
it terminate abruptly, but diffuses itself gradually 
and imperceptibly into the surrounding p^rts ; in 
which circumstance, it differs from chancre so evi- 
dently, as to be at once distinguished by an expe- 
rienced practitioner. 

The induration of a chancre is not confinet} to 



SCALY VENEREAL DISEASE. 287 

the edges only, but extends under the entire sur- 
face of the ulcer. We often meet with chancres in 
which the ulceration is inconsiderable, when com- 
pared to the extent of the induration ; and even in- 
stances of an indurated knob^ or tubercle, on the 
penis, without any visible ulcer, which have been 
followfed by the constitutional symptoms of syphi- 
lis, are not uncommon ; but on enqitiry, we shall 
probably learn, that in every such instance, a small 
ulcer existed at first on the callous part, which 
healed under the use of some locd applications. 
Chancre is, in fact, an indolent ulcer, and makes but 
slow progress, compared to those ulcers of the parts 
of generation, which are destitute of any surround- 
ing induration, and particularly the phagedenic and 
sloughing ulcers. 

It is to be recollected in forming our diagnosis 
respecting chancre, that frequent irritation is capa- 
ble of producing around the most simple sore con- 
siderable induration; and experiments have been 
made which are stated to have produced so great 
a degree of callosity, as to deceive the most experi- 
enced practitioners. Whether irritation is capable 
of causing a hardness which might be mistaken by 
an experienced person for the remarkable callosity 
that characterises chancre, I cannot determine, and 
very much doubt the circumstance. But in form^ 
ing our diagnosis we should always take into consi- 
deration the previous management of the ulcer. 

Chancre, when situated on the body of the penis, 
IS of a dark livid colour ; the ulcer is not excavated, 
but is on a level with the surrounding parts. It is 



288 scalV venereal disease* 

attended with less induration than the excavated 
chancre ; and in the cases which came under my 
observation was generally from the size of a six- 
pence to that of a half-crown, and sometimes even 
extended round the body of the penis. Its edges 
are a little raised, and the surrounding induration 
very perceptible to the touch, though not in so great 
a degree as the chancre described by Hunter. 

If mercury is employed, the ulcer soon assumes 
a healthy appearance ; but if that medicine be not 
resorted to, its livid surface is alternated, every third 
or fourth day, with that of a light brown or tawny co- 
lour. The ulcer, at the same time, extending its 
dimensions slowly, and, as it advances, the surround- 
ing induration obviously increases. As few have 
witnessed this alteration of colour in a chancre, on 
account of the immediate exhibition of mercury, it 
ma}^ be of service to relate an instance. 

Case 49. — William Murray, setat 25, was admit- 
ted, February 1 1th, 1813, into the hospital. He was 
affected with phymosis, accompanied by discharge 
under the prepuce. An ulcer, about the size of a 
bean, of a livid colour, with callous edges slightly 
elevated, was situated on the body of the penis ; he 
had not used mercury previously to his admission, and 
I directed him merely to poultice the penis mth 
bread and water. 

On the fourth day from his admission, the ulcer 
had assumed a light brown, or tawny colour, and its 
edges had become more callous and elevated. 

On the sixth, it again exhibited the dark livid ap- 
pearance ; the penis was considerably swollen, and 



SCALY VENEREAL DISEASE. ' 289 

the patient complained of pain which deprived him 
of rest. 

On the ninth day, the livid surface of the ulcer 
was changing to the same tawny appearance as be- 
fore, a rash, or efflorescence (roseola annulata) over- 
spread different parts of his body, agreeing with the 
appearance described by Mr. Hunter in the follow- 
ing words : " The disease in the skin first shows 
itself in discolouration, making the skin appear 
mottled, many of them disappearing, while others 
continue and increase with the disease."* 

On the eleventh, the entire ulcer assumed the 
tawny colour. The efflorescence of the skin had 
disappeared in some places, while it appeared in 
others, and there was a swelling of the glands in the 
right groin. 

On the seventeenth day the ulcer was again livid, 
and had extended to the size of a shilling ; the sur- 
rounding induration had also increased. 

As the character of the ulcer w^as sufficiently es- 
tablished by the increase of the callosity, mercurial 
frictions where now prescribed, and these, in a few 
days, caused a favourable change in the ulcer. He 
was discharged the hospital well in a month after- 
wards, having undergone a smart mercurial course. 

The dark livid appearance of this chancre, when 
extensive, bears some resemblance to that of the 
sloughing ulcer, and may possibly be mistaken for 
it. They may, however, be distinguished from each 
other, by the indurated edge and base of the chan- 

* Hunter, p. 476. 
2o 



290 SCALY VENEREAL DISEASE. 

ere, which are not attendants upon the sloughing 
ulcer; and, on a close inspection, the surface of 
the chancre, though dark, will not exhibit a state of 
slough or mortification. Its progress is slow, and, 
in both of these circumstances, there is an obvious 
and remarkable difference between these ulcers. If 
any doubt, however, should still remain, a little de- 
lay will disclose the true nature of the ulcer. If 
chancrous, it will, in three or four days, assume the 
tawny appearance already mentioned; and, if slough-r 
ing, the process from which it derives its name, will 
continue to extend, or the sloughs to separate and 
expose to view a corroding ulcer, to all appearance 
phagedenic, but which is soon covered by a slough 
that is again thrown off? again to be renewed, till 
the part is destroyed, or perhaps the patient. 

Phymosis and inflammation are less frequently 
attendants upon chancre than upon those ulcers 
which are destitute of its characteristic marks ; but 
when they accompany the former, they ought pro- 
bably to be ascribed to a very irritable habit, or to 
some irregularity in the patient, rather than to any 
stimulating quality of the poison which disposes it 
to excite inflammation. 

It is not very likely, that the distinction existing 
between syphilitic buboes, and those from other 
causes, before ulceration takes place, will ever be 
discovered ; and even in the ulcerated state, it is 
almost impossible, with any certainty, to point out 
such discriminating marks as will clearly distinguish 
them. The following circumstances, in conjunction 
with the history of the disease, may assist in form- 



SCALY VENEREAL DISEASE^ 291 

ing a diagnosis. Syphilitic buboes have frequently 
aching pains ; in vi^hich respect they differ from in- 
dolent ulcers of the groin, which seem to maintain 
themselves by habit. The bottom of the syphilitic 
bubo, which has not been affected by mercury, has 
frequently a callous feel, and is either of a dark foul 
appearance, or of a light brown tawny colour. If 
an ulcer of this description spreads, we may, with 
confidence, have recourse to mercury ; and we shall, 
in most instances, find, that quick amendment fol-^ 
lows its exhibition. 

If the tumour in the groin has not been preceded 
by an ulcer on the genitals, mercury is unnecessa- 
ry, and may be highly injurious. I am not in the 
habit of ordering that medicine for buboes which 
have not been preceded by chancre ; yet the sub- 
sequent appearance of syphilitic constitutional sy mp-^ 
toms has never, in any instance, occurred; or any 
other circumstance, to induce me to repent of this 
line of practice. 

When the syphilitic matter is absorbed into the 
general mass, the first constitutional symptoms ap- 
pear upon the skin, throat, or mouth, and afterwards 
upon the periosteum, bones, and other deep seated 
parts. 

The eruption on the skin is usually considered 
the first constitutional symptom, but ulceration of 
the throat is as frequently the earliest intimation we 
have that the disease is become general. Before 
the occurrence of these local symptoms of a gene- 
ral disorder, there is often observed, considerable de- 
rangement of the patient's constitution. His coun- 



292 SCALY VENEREAL DISEASE. 

tenance is dull and palid; and he complains of rest- 
lessness, want of sleep, and often head-ach. This 
derangement is analogous to the fever which pre- 
cedes the eruption in the different species of the 
venereal diseases as described, and in the exanthe- 
mata; but in the latter class of disorders, as the 
eruption appears, the fever diminishes : and the con- 
stitution completely gets the better of the disease, 
by its own unassisted powers. Not so in syphilis ; 
the slow fever which precedes the constitutional 
symptoms, may subside on their first appearance, 
but the irritation from the unsubdued poison still 
remaining, the same effort for relief is renewed ; in 
other words, the fever returns, but at uncertain in- 
tervals, till the constitution is worn out, or the in- 
tervention of medicine excites an action sufficient 
to supersede the syphilitic irritation. Hence, Mr. 
Hunter very properly observes, that this habitual 
fever of syphilis partakes very much of the nature 
of hectic fever, which he esteems to be an effort of 
the constitution to rid itself of a disease, but which 
it is inadequate to accomplish. 

The eruption in syphilis is frequently preceded 
by an efflorescence of the entire skin, which has 
been noticed by Hunter. Doctor Willan remarks 
that it is similar to the roseola annulata, and gives 
the skin a mottled red appearance ; an instance of 
which I have already adduced, in a case of livid 
chancre. 

The true syphilitic eruption is scaly ; a circum- 
stance by which it may be distinguished from the 
eniptions of the other forms of venereal disease, 



SCALY VENEREAL DISEASE. 293 

which we have seen are either papular, pustular, or 
tubercular. No author describes this eruption so 
clearly as Doctor Wiilan, in his admirable work 
upon Cutaneous Diseases. It is true, he also de- 
scribes as syphilitic, the papular eruption, under 
the term of lichen syphiliticus; and I am perfectly 
aware that the first writers on syphilis introduce 
this epithet, pustular, in their description of its 
eruption ; as, also, that the disease, in many coun- 
tries of Europe, received its name from the appear- 
ance of the eruption. But whether that appear- 
ance was papular, pustular, scaly, or tubercular, is 
not very evident from those denominations ; which, 
singly, might afford a clue, but taken in conjunction, 
seem to confound together all those different spe- 
cies of eruption.* But we are under the necessity 
of recollecting, that at the period in question, there 
was but little regard paid to the distinctive charac- 
ters of cutaneous diseases; and that every appear- 
ance on the skin, which happened to terminate in- 
ulceration, or produce a discharge of matter, was 
termed a pustule. 

This is apparent in the writings of all the older 
authors, who treated on the subject; and even As- 
true himself, who published his work in 1735, seems 
to confound every species of eruption together, as 
is evinced by the following passage: "Pustules or 
ulcerous tubercles of the skin, both such as are pu- 

* According to Astruc, the Spaniards called it Las Bubas, Bu- 
vas, Buas or Boas. The Genoese, Le Male de le Tavelle, The 
Tuscans, II malo delle Bolle. The people of Lombardy, Lo ma- 
lo, de le Brosule ; and the French, La Vairole or Verole. See 
book L page 4, , 



294 SCALY VENEREAL DISEASE. 

rulent, and such as are dry and crusty, not only ap- 
pear in the venereal disease, but likewise in many 
others ; as, in the scurvy, tetters, scab, and in all 
other cutaneous distempers.*** In fact, there was 
not any accurate distinctions of the various erup- 
tions that occur on the skin till our own time ; w hen 
Doctor Willan classed, according to their external 
characters, diseases, which previously were not un- 
der any regular arrangement. 

I have to add, that I have not, in any one instance, 
observed the eruption to be papular, pustular, or tu- 
bercular, when it arose from the true syphilitic pri- 
mary ulcer ; or to be scaly, w hen it followed those 
ulcers which do not possess the characters of chan- 
cre, the indurated edge and base. A few pimples 
occurring on the face of a man, affected with the 
scaly syphilitic eruption, ought not to be consider- 
ed as an exception to this statement, for, in order 
to form a fair judgment on the nature of a general 
eruption, the appearance of the entire surface of the 
body should be taken into consideration. 

The following is Doctor Willan's description of 
the syphilitic eruption, which he places among the 
scaly eruptions, and in the order lepra. " In the 
venereal disease, circular patches sometimes ap- 
pear, w^hich resemble those of the lepra nigricans 
in size and colour, but which are not incrusted. 
The dryness and harshness of the skin, so remarka- 
ble in the lepra vulgaris and alphoides, do not oc- 
cur in the venereal lepra ; its patches, when some- 
what advanced, being as soft and pliable as other 

"^ Astnic. p. 50. 



SCALY VENEREAL DISEASE. 295 

j3arts of the skin. It is, however, proper to observe, 
that every patch originates from a small, hard^ red- 
dish protuberance. As this gradually dilates, the 
increase of its circumference is not attended with 
an increasing ulceration of the centre ; on the con- 
trary, the sides of the patch are somewhat raised, 
and the central part of it appears a flat surface co- 
vered with thin white scales. The patches are ge- 
nerally distinct, and at a distance from each other. 
There is seldom seen any of them exceeding the 
size of a shilling; yet, it is probable, they might ac- 
quire a greater magnitude, if the progress of the 
disease were not arrested by the use of mercury. 
When the constitution is under the full influence of 
mercury, the sides of the patch shrink and become 
paler ; the centre is also depressed, but the desqua- 
mation proceeds slowly ; and the disease cannot be 
removed, without a perseverance in the course for 
six or eight weeks. A circular red spot usually ap- 
pears, for some time in the place of every declining 
patch ; and a minute shallow depression, like a ci- 
catrix, is left at the centre ; but no permanent dis- 
colouration of the skin remains, as in some cases. 
The leprous form of the syphilitic eruption takes 
place, like other venereal eruptions, at very differ- 
ent periods after infection, in different cases. If no 
medicines were employed, it would at length ter- 
minate in ulcerated blotches."* 

Dr. Willan also describes another scaly appear- 
ance of the syphilitic eruption, under the species 
psoriasis, of the same order. The only difference 

* Willan, p. 129. 



296 SCALY VEx\EREAL DISEASE. 

between this and the other is, that the spots in the 
former are circular and larger, and in the latter, they 
are irregular, smaller and less elevated. (See plate 
V.fig.4.) 

The scaly syphilitic eruption is almost in every 
instance, to be found on the forehead, breast, back 
of the neck, on the groins, and adjoining surface of 
the pubes. On the back of the neck and groins, 
those spots situated near the parts covered with 
hair, spread into each other, so as to form extensive 
copper-coloured blotches, as are represented in 
plate V. %. 1,2, and 3. 

On the palms of the hands, or soles of the feet, 
its appearance is different from that on other parts. 
The cuticle separates, and is quickly succeeded by 
another ; and this process may be several times re- 
peated, for the thick skin of those parts has not the 
same disposition to form scurf, as the common skin ; 
for which reason, if a case would arise, in which the 
appearances were confined to the hands and feet, it 
would be impossible to determine, whether or not 
it were syphilitic ; for all diseases affecting the cutis 
of those parts, produce a separation of the cuticle, 
attended in all with the same appearances. 

When the eruption affects a skin which is oppos- 
ed by another skin, as, between the nates, or be- 
tween the scrotum and thigh ; or under the arms, or 
between the thighs, it is not scaly ; but the skin be- 
comes elevated into a moist, soft, flat, or somewhat 
convex surface, which discharges a whitish matter. 
These are the appearances which, L believe, in au- 
thors, are termed condylomata, fici, crista?, mariscae. 



SCALY VENEREAL DISEASE. 297 

&c. denominations applied, according to their figure, 
or perhaps the fancy of the practitioner. 

In this stage of the disease, that part of the fin- 
gers and toes upon which the nail is placed, is often 
attacked. A separation of the nail follows, similar 
to that of the cuticle in the eruption of the skin ; but 
Mr. Hunter well observes, there cannot be here 
that regular succession of nails, as of cuticle. 

If mercury is not employed, the eruption pro- 
ceeds to ulceration in the following manner. Each 
spot is covered by scales, or by scurf, which is 
thrown off, and succeeded by another ; every suc- 
ceeding scurf which is formed, becomes thicker 
than the preceding, till, at length, it forms a crust 
under which matter collects, and it becomes a true 
ulcer ; in which state it spreads but very slowly. 

The next constitutional symptom of syphilis, is 
the ULCERATION OF THE THROAT; where the tonsils, in 
most instances, are the seat of the disorder. The 
ulcer forms without much previous pain or swelling, 
although it soon produces a considerable excavation 
in the tonsil. It is, as Mr. Hunter observes, " a fair 
loss of substance ; part being dug out, as it were, 
from the body of the tonsil, with a determined edge, 
and is commonly foul, with thick white matter ad- 
hering to it, like a slough, which cannot be washed 
away."* This is the description of a well-marked 
syphilitic ulcer of the throat ; but as the tonsils are 
sometimes deeply ulcerated in the phagedenic dis- 
ease, we can only ascertain the nature of the ulcer 
m question by a most careful examination of tha 

* Hunter, p. 482. 

2p ' ^ 



298 SCALY VENEREAL DISEASE. 

patient, in order to discover the character of any 
other ulcer or eruption he may have; which, to-^ 
gether with an accurate knowledge of the history 
of the case, will seldom leave us in doubt with re^ 
spect to the nature of the disease. 

It is scarcely necessary to mention here, a very 
common affection of the tonsils, noticed by Mr, 
Hunter, which is not unfrequently mistaken for a 
syphilitic ulcer, viz. chronic inflammation of those 
glands, attended with irregularity of their surface, 
which is covered with coagulable lymph, that gives 
it the appearance of ulceration. 

Any mercurial affection of the throat is easily 
recognized, by the mercurial foetor of the breath, 
which accompanies it. The use of this medicine 
may caijse considerable inflammation and ulcera- 
tion of any part of the fauces, particularly if the 
patient should expose himself to cold and wet, when 
under its influence. 

I have witnessed, in a very considerable number 
of instances, profuse ptyalism, in patients who had 
not used mercury; but all thus affected, had, at the 
same time venereal ulcers of the fauces. It is pro- 
bable, that this spontaneous salivation is a constitu- 
tional symptom of syphilis, and analogous to a sim- 
ilar occurrence in small-pox. I am not inclined to 
attribute it to the irritation of the ulcers of the 
throat upon the mouth and salivary glands; for the 
syphilitic ulcers in question were attended with 
scarcely any pain. It is a curious circumstance in 
these cases (but one which I would naturally ex- 
pect from this view of their nature,) that as the pa^ 



SCALY VENEREAL DISEASE. 299 

tient becomes affected with mercury, the salivation 
begins to diminish, and, at length, entirely ceases ; 
but is renewed again, as the mercurial process is 
farther advanced; first arising from the disease, and 
afterwards from the remedy. 

The BONES, PERIOSTEUM, FASCIjE, AND LIGAMENTS) arC 

the deep seated parts most liable to the attacks of 
the syphilitic poison, and it is generally thought, are 
affected after the disease has appeared constitution- 
ally on the superficial parts of the body, if the dis- 
ease has not been arrested in its progress by mer- 
cury, which disturbs the regular succession of the 
symptoms. 

Of the bones, it is observable, that those nearest 
the surface are most liable to the disease, as the ti- 
bia, sternum, clavicle, and cranium. When the 
deeper seated parts are affected, the progress of the 
disease is more gradual than in the superficial. 
Swellings of the testes, tendons, and fasciae are in 
general, very indolent, do not excite any pain, and 
have very pmch the character of scrofulous swel- 
lings. 

The true syphilitic node is a solid enlargement of 
the bone, and is not at its commencement, nor for a 
considerable period afterwards, accompanied by any 
discolouration of the integuments. It is, in most 
cases, a very indolent swelling, increasing by slow 
degrees, and exciting but little pain and inflamma- 
tion until in an advanced state. 

The true syphilitic pains are generally supposed 
to affect the centre of the long bones, but this is not 
universally the case ; while those of the resembling 



300 SCALY VENEREAL DISEASE. 

diseases, as we have observed in its proper place, 
affect the joints, and all in common with other aches 
or pains, have their exacerbation at night. 

It is most satisfactory to observe the certainty 
and rapidity mth. which the constitutional symp- 
toms of syphilis affecting the soft parts, yield to 
mercury. The scaly eruption begins to decline, 
even before it is observed to affect the system, and 
ulcers of the skin and throat, as soon as that event 
takes place, assume a healthy and granulating as- 
pect, and soon afterwards cicatrize. The same 
good effects are also observable in the soft eleva- 
tions of the skin which are found between the nates, 
under the scrotum, and in the axillae. The ulcers 
of the tonsils also immediately ajnend. All these 
secondary symptoms yield much more rapidly than 
chancre to mercury; in illustration of which, it is 
but necessary to mention, that if the same person is 
at the same time, affected with chancre and the 
constitutional symptoms above enumerated, the lat- 
ter will yield much sooner than the former to this 
remedy. A circumstance, which I have elsewhere 
stated, would induce us to suppose, that the syphi- 
litic virus undergoes some chan2:e in its transmis- 
sion through the system, and is thereby rendered 
less virulent; and this supposition, as observed by 
Dr. Adams, is farther confirmed by the incapabilit}' 
of the matter of constitutional ulcers to communi- 
cate the disease, contrary to the effects of the other 
poisons, as, for instance, that of small-pox. 

It must be allowed, that syphilitic nodes by no 
means yield to mercury with the same regularity 



SCALY VENEREAL DISEASE. 301 

and quickness as the constitutional affections of the 
surface of the body ; a circumstance most probably 
owing to the organization of tiie bones, which is so 
low, that the strongest mercurial action in the skin 
and throat, may be accompanied by a very weak 
one in the vessels of the former. Yet, in the most 
obstinate instances, I doubt the propriety of con- 
tinuing a full mercurial action longer than two 
months. This period is more than suflicient to su- 
persede the syphilitic action, if managed w ith judg- 
ment. I have always found it unnecessary to per- 
severe in the use of mercury, until the tumour of 
the bone is entirely removed. And there can be no 
doubt, that if the node remains after a judicious 
course, we should regard it merely as a simple en- 
largement of the bone, deriving no character what- 
ever from its syphilitic origin. 

Syphilis, like other contagious diseases, is obedient 
to certain laws, from which there is little deviation; 
but from the details of most authors, it would ap- 
pear that it possesses but little uniformity in its 
symptoms, or regularity in its progress. This opi- 
nion of the multiform appearance, and irregular 
course of the disease, is occasioned by several cir- 
cumstances : — 

1.-^ — Ulcers on the genitals, which are not syplii- 
litic, are frequently mistaken for syphilitic, and 
treated accordingly; and this is a source of error, 
not only in respect of the original disorder, but in 
the entire train of complaints which may arise from 
the distemper thus mistaken. 

2.--If the primary complaint is syphilitic, the 



302 SCALY VENEREAL DISEASE. 

progress of the disorder is interrupted by the use 
of mercury, and if it is not totally subdued by that 
remedy, its return occurs at uncertain intervals. 

3. — There are a number of complaints which arise 
from the use and abuse of mercury, which are fre- 
quently mistaken for the symptoms of syphilis; for 
instance, erratic pains, diseases of the viscera, ner- 
vous affections, mania, fatuity, and a variety of other 
complaints, which can evidently be traced to the 
imprudent use of this medicine. 

In the treatment of true syphilis, there is nothing 
perplexing or dubious, if we except the mercurial 
phagedena, and other effects of that mineral, which 
may be mistaken by the inexperienced, for the 
symptoms of syphilis. But the remedy in the hands 
of the experienced practitioner, will remove, I may 
say with certainty, every symptom of that disease, 
both local and constitutional. 

I am decidedly of opinion, that mercury acts by 
exciting an irritation capable of superseding that of 
the syphilitic, and in this point of view, it can be of 
little consequence, by what quantity of mercury, 
whether little or great, that irritation has been ex- 
cited. By referring to the hospital books, I find 
that numbers have been cured both of primary and 
secondary symptoms, by a very small quantity of 
mercury. Frequently from an ounce to two ounces 
has been found sufficient to cure the disease, and of 
preserving a strong mercurial irritation in the sys- 
tem, from one to two months; and this I suspect is 
all that is required; even if one drachm w^as found 
capable of producing this effect, I should not think 



bCALY VENEREAL DISEASE. 303 

bf administering an additional grain. But whatever 
be the quantity, it is necessary for the cure of sy- 
philis, to excite a strong mercurial action, and to 
make the constitution feel and suffer under the de- 
bilitating effects of the mineral. Alterative courses, 
as they are termed, may suspend, but will seldom 
supersede the poison altogether.* 

In stating the very small quantity of mercury I 
have found capable of exciting strong mercurial ac- 
tion in the system, and of thus curing the disease, 
we must take into consideration the warmth and 
mercurial atmosphere of a hospital ; and therefore 
in private practice we are not to expect a result per- 
fectly similar. 

It is not a little perplexing, that a primary vene- 
real ulcer may be affected by the mercurial phage- 
dena, without having the action of its poison en- 
tirely superseded, for after the phagedena is remov- 
ed, we too frequently find, that the ulcer, instead of 
healing, assumes again the venereal character, so 
that it appears as if the venereal action had only 
been suspended, and not extinguished in the part. 
We ma}^, perhaps, better account for these succes- 



* The author, in the last words of this paragraph, recommends 
more mercury than will be found requisite, in the treatment of 
this or any other form of Syphilis, which appears in the practice 
of Philadelphia. In fact, since it is now proved beyond a doubt, 
that every variety of the disease may be readily cured without 
the use of mercurials of any kind, it would certainly appear at 
least injudicious '^ to make the system feel, and suffer under the 
debilitating effects of the mineral." Such a course mig-ht be ex- 
pected to defeat one of the most important intentions of the 
author's excellent work; that is to say, to lessen the evils arising 
from the improper admiaistration of mercury.. E. 



304 SCALY VENEREAL DISEASE. 

sive morbid changes, by supposing that the mercu- 
rial phagedena had not extended to every part of 
the ulcer, but that some minute portion of it still 
continued under the syphilitic action, and conse- 
quently secreted a contagious poison ; but as soon 
as the mercurial phagedena has subsided, there is 
reason to believe, that the remainder of the ulcer be* 
comes affected by the poison, and the entire sore 
consequently assumes the syphilitic action. These 
circumstances are elucidated by the progress of ul- 
cerated buboes, in which the mercurial phagedena 
more frequently occurs than in any other venereal 
ulcer, on account of the practice of opening them 
while the system is mercurially affected. The 
crude wound inflicted by the lancet in opening them, 
if the system is affected by mercury, Avill immediate- 
ly assume the mercurial phagedena, which will ra- 
pidly extend, although a sufficient quantity of mer- 
cury has not been exhibited to supersede the vene- 
real irritation in the part. The same circumstance 
will occur in the suppurating sore made b}^ caustic, 
and in either case we have an instance of mercurial 
action in one portion, and of venereal action in an- 
other portion of the same ulcer. 

I have never seen the mercurial phagedena as it 
appears in chancre and bubo, (in which it exhibits 
a peculiar fiery red colour,) affect ulcers of the 
throat in the same manner; but I have frequently 
seen a dark foul phagedenic ulcer make its appear- 
ance, and extend along the edges of the velum and 
uvula in patients strongly affected by mercury, 
which I suspected was caused by that medicine. 



SCALY VENEREAL DISEASH:. 305 

Bat to decide that this was actually the case, re^ 
quires much farther observation than I had an op* 
portunity of bestowing. It is, however, certain, that 
we every day meet with cases in which merpury 
produces high inflammation of the fauces ; and, oi) 
inspection, the velum and uvula appear of a deep 
red colour, and their edges exhibit a peculiar white 
excoriated appearance. 

The ulceration of these parts is the same as that 
which occurs on the tongue and inside of the cheeks, 
during a severe salivation; and which is occasioned 
by the pressure of the dentes molares. The mer- 
curial foetor in the mouth is sufficient to point out 
the true nature qf these affections, whenever they 
occur. 

It is supposed by many that mercury is capable 
of producing nodes upon a sound bone, as they very 
frequently occur while the constitution is under its 
influence ; but I should be unwilling to admit thi^ 
as a fact, until I shall have an opportunity of wit- 
nessing the appearance of nodes, in persons under 
the influence of mercury, for any disease not vencr 
real; because I have frequently found, that the mer- 
curial irritation of the system will not prevent the 
accession of nodes, ii) thq pustular or phagedenic 
venereal diseases ; and, therefore, their occurrence 
may have been erroneously attributed to the mer- 
cury employed; while, in fact, they were pro4uced 
by the agency of a morbid poison. 

But although I would not, without farther proofs, 
ascribe the production of nodes to the operation of 
mercury, I will, without hesitation,' admit, that it is 

3q 



306 SCALY VENEREAL DISEASE.. 

often the cause of pains which are frequently mis- 
taken for the effects of the venereal poisons. Such 
as are produced by mercury, are found to affect the 
muscles, tendons, and joints, and have a strong re- 
semblance to those of rheumatism. These pains 
are usually produced by exposure to cold, while the 
patient is under the influence of mercury. I have 
not, however, any doubt, but that pains in the joints, 
very generally ascribed to mercury, are, in fact, at- 
tributable only to one or other of those poisons 
which resemble syphilis in their symptoms; for we 
have found that one of their most prevailing cha- 
racteristics is to excite pains in the larger joints, 
which mercury is incapable, in the greater propor- 
tion of cases, of removing : and even if the}- are di- 
minished by its influence, they return with increas- 
ed severity, as soon as the mercurial irritation of the 
system has subsided. 

Besides the usual and characteristic local and 
constitutional effects of mercury, there are two singu- 
lar affections, which not unfrequently attend its use. 
The one is the erethismus mercurialis described by 
Mr. Pearson,* and the other is a peculiar eruption, 
which has received different appellations from the 
authors who describe it.t These diseases are not 
dependant upon the quantity of mercury absorbed 
into the body, or upon the preparation, or mode of 



* Pearson's Observations, S^c, p. 196. 2d edit. 

t Doctor Alley calls it HN'drarg-yria ; Dr. Moriarty, Lepra Mer- 
curialis; Doctor Speas, Erythema Mercuriale : and Doctor Bate- 
man places it as a variety of Eczema Rubrum, in the order vesi- 
culae. 



^CALY VENEREAL DISEASE. 307 

administering that remedy,* but seem rather to arise 
from a peculiarity of constitution in the patient; the 
cause of which, in our present state of knowledge, 
is not likely to be discovered. 

I have observed, that females are in general more 
easily affected by mercury than males ; and, there- 
fore, always direct them to begin with half a drachm 
of ointment every night ; and, in almost every in- 
stance find, that this quantity is sufficient to induce 
a proper degree of irritation in the mouth, in the 
usual time, which may be estimated at six or eight 
days after the commencement of the course ; and if 
a considerable soreness is produced in twelve, it 
may be esteemed an adequate commencement. On 
my first appointment to the Lock Hospital, I pre- 
scribed, as was the general practice, a drachm of 
ointment every night for the females, not making any 
/distinction between them and the other sex. But, 
having continued this plan for some time, I found 
that no precaution could prevent the most exces- 
sive salivations, attended with dysenteric affections, 
extreme debility, and sometimes dropsy ; but when 
I adopted a more considerate practice, I found the 
most beneficial advantages. These severe effects, 
from the usual mode of exhibiting mercury, may ap- 
pear surprising, but we should recollect the debili- 
ty arising from frequent courses, to which those wo- 
men who frequent Lock Hospitals are accustomed, 

* I know a gentleman who has always been attacked by this 
eruption, when he took but a single grain of calomel. I also 
knew an instance of" the disease being produced by the application 
©f the black mercurial wash to a venereal ulcer. 



308 hCALY VENEREAL DISEASE. 

and the influence of a mercurial atmospliere, such 
as was formerly present in hospitals restricted to 
venereal patients. 

When a patient^ whether male or female, has 
been salivated several tiiiies, and the system there- 
by habituated to mercur}^ it is incredible the small 
quantit}^ of that mineral that is sometimes capable 
of exciting the severest effects. The following 
case, one of the most remarkable I have inet with, 
will elucidate the fact. 

Case 50. — Daniel Nowlan, setat. 30, was admitted 
into the hospital on the 26th of December, 1811, af- 
fected with sj^philitic ulcers of the tonsils, and an 
enlargement of both testicles. He recently was in 
the hospital for six months, and had been discharg- 
ed the preceding April, after suffering repeated 
heavy saliviatibns for an ulcer on the glans penis, 
which entirely destroyed the part. 

i directed him to rub in half a drachm of oint- 
inent every night. In four days his mouth was so se- 
verely aflected, that he spat two quarts in twenty- 
four hours; and although he had used but two 
drachms of ointment, the mercurial affection of his 
system increased afterwards to so alarming a height, 
that his face and entire head became swollen in an 
extraordinary degree. His tongue projected from 
his mouth, its edges were ulcerated, and of a white 
sloughing appearance. He lay in a state of insensi- 
bility, or coma, and his breathing was laborious, like 
a man affected with apoplexy. 

He was removed to the convalescent ward, and 
was directed a smart opening medicine daily ; under 



SCALY VENEREAL DISEASE. 309 

tliis, and other appropriate means, the dangerous 
lethargy in which he lay was removed, but he was 
not able to resume the use of mercury until the be- 
ginning of February following; and it is remark"* 
able, that he afterwards bore the exhibition of mer^ 
cury like other patients, being able to rub in three 
ounces and a half of ointment before the 20th of 
March following. 

If a similar case were again to occur, I should 
conceive it necessary, during the comatose state, to 
take blood as freely as I w^ould in a case of apoplexy. 

If the system has been debilitated by reiterated 
courses of mercury, oedematous sw ellings of the legs 
is a very frequent occurrence. It is an event which 
should w^arn the surgeon not to give another grain 
of mercury, but to make use of such means as are 
calculated to recruit the broken constitution of his 
patient. And I believe, for this purpose, country- 
air, generous diet, and exercise proportioned to his 
strength, will be found more effectual than medi- 
cine. If mercury be persevered in after oedema 
makes its appearance, general dropsy will follow; 
and it is surprising the rapid progress it makes in 
such cases. In a few days I have seen the entire 
cellular membrane of the body (Edematous, with as- 
cites, and every symptom of hydrathorax. 

Nitrous acid, given in as large quantities as the 
stomach and bowels can bear, conjoined with digi- 
talis, is of the greatest service in these cases. The 
following instance will evince the rapid progress of 
dropsy, under those circumstances, and the utility 
of the practice recommended. 



310 SCALY VENEREAL DISEASE. 

Case 51. — John Delany was admitted into the 
hospital the 26th of Januan^, 1813, on account of a 
foul ulcer, situated on a remnant of the glans and 
prepuce ; the greater portion of those parts having 
been destroyed by former ulceration. There were 
also numerous ulcers on his arms and shoulders, 
covered by large crusts. During the preceding 
year his constitution had suffered under reiterated 
courses of mercury, administered on account of an 
obstinate ulceration of the glans and prepuce ; and at 
the time of his admission, his countenance Vvas 
bloated, and his legs and thighs anasarcous. 

Under these circumstances, I did not deem it ex- 
pedient to employ mercury, but merely ordered him 
nourishing diet, and decoction of sarsaparilla. 

Feb. 1st. — His dropsical symptoms having in- 
creased with considerable dyspncea, and (Edematous 
swelling of the scrotum, I put him on the use of 
nitrous acid, conjoined with digitalis; from fifteen* 
to thirty drops of the tincture were taken in half 
a pint of nitrous acid mixture thrice a day. 

8th. — He passed urine in large quantities; the 
swelling of his limbs and scrotum had considerably 
diminished; and I had the satisfaction of observing 
at the same time, that the ulcer of the penis had as- 
sumed a disposition to heal. 

16th. — The dropsical symptoms had nearly dis- 
appeared, but the ulcers on his arms were extend- 
ing, and he complained of severe pains in his wrists. 
The nitrous acid and digitalis were discontinued, 
and he was ordered the decoction of sarsaparilla, 
and 30 drops of antimonial wine three times a day. 



SCALY VENEREAL DISEASE. 



311 



March 1st. — The ulcer of the penis had healed, 
and many of the crusts had fallen off, and left the 
parts underneath perfectly cicatrized ; at the same 
time several papulag appeared on different parts of 
his body, and he complained of severe pains in his 
wrists and shins, particularly at night. The decoc- 
tion and antimonial wine were continued. 

14th. — He was discharged the hospital, all the 
constitutional ulcers having healed; the pains being 
dissipated, and the oedematous swelling entirely re- 
moved. 

The greatest circumspection is necessary in the 
exhibition of mercury in persons labouring under 
the slightest pulmonary affection, whether it be he- 
moptoe, asthma, or dyspnoea, from whatever cause 
it may originate. I have seen in the Lock Hospi- 
tal repeated instances of the fatal effects of mercury 
in such cases ; but it is certain, that the mercurial 
atmosphere of the house contributed in no small 
degree, to the danger of the patient ; and it is abso- 
lutely necessary that there should be annexed to 
every foundation of this description, convalescent 
wards detached from the hospital, and enjoying the 
advantage of a pure atmosphere.^ The justice of 
these remarks will be confirmed by the following 
case : — 

Case 52.— Owen O'Neale, fetat. 30, was admitted 
with chancres attended by considerable inflamraa- 

* 1 leave the above passage as it stood in my fii*%t edition in 
1814; but the small quantity of mercury at present employed 
even by those of the old school, compared to what was given at 
that period, would, 1 am now inclined to think, render such an 
establishment sunerfluous. 



312 SCALY VENEREAL DISEASE. 

tion of the prepuce, on the 6th of December, 1811. 
He had a large curvature of the spine, and a corre- 
sponding distortion of the chest, and his counte- 
nance was of that livid hue which marks impeded 
or imperfect respiration ; he had also a severe cough. 

I directed twelve ounces of blood to be drawn im- 
mediately from his arm, not only with a view to the af- 
fection of his chest, but to the inflammation of the 
penis. The antimonial solution was also ordered. 
Three days afterwards, his breathing was so much re- 
lieved, that I did not think it necessary to postpone 
any longer the exhibition of mercury, and I direct- 
ed him to rub in but half a drachm of ointment every 
night, and to persevere at the same time, with the 
antimonial solution. 

On the 29th, the chancres had improved, and his 
mouth w^as slightly aff'ected by the mercury, but his 
breathing, on the preceding night, had again be- 
come laborious, and his pulse was upwards of 100. 

He was removed immediately to the convales- 
cent ward, sixteen ounces of blood were taken from 
his arm, the ointment was discontinued, and the an^ 
timonial solution persevered in. 

On the 21st, 22d, and 23d, the venesection was 
repeated each day. Blisters were applied to his 
breast and back, but the different means employed 
were ineffectual in checking the progress of the af- 
fection of his chest. On the 25th, his respiration 
was rapid, pulse 130, and countenance livid; in 
short, there was every symptom that effusion had 
taken place into the che^t or lungs ; and on the 27th 



SCALY VENEREAL DISEASE. 313 

died, not having rubbed in more than four drachms 
of ointment from the time of his admission. 

This is a striking example of the ill effects of 
mercury, and a mercurial atmosphere, in persons la- 
bouring under pulmonary complaints. No neces- 
sary precaution was omitted before the adoption of 
the medicine, and the caution that was obsen^ed dur- 
ing its exhibition, would under other circumstances 
have been altogether superfluous. But in such 
cases, no caution can be excessive. The frequency 
and rapidity of effusion into the lungs or chest of 
patients labouring under pulmonary complaints, 
while exposed to the mercurial atmosphere of an 
extensive Lock Hospital, is too common a subject 
of observation, and can only be remedied in the 
mode I have already recommended. 

Before I conclude this part of the subject, it may 
be of service to recapitulate the usual and charac- 
teristic effects of mercury on the frame, and like- 
wise those effects which now and then occur from 
its use, and which seem to originate in peculiarity 
of constitution : — 

1 . Mercury induces a specific fever different from 
all others, and attended with an increase of the va- 
rious secretions. 

2. When the constitution has been incessantly 
harassed by mercury, it induces dropsy, various 
nervous affections, epilepsy, mania, and fatuity. 

3. It produces peculiar local effects. A crude 
wound or suppurating sore, under its influence, will 
immediately become spreading phagedenic ulcers, 
of a fiery red appearance. The ulcers of morbid 

2 R 



314 SCALY VENEREAL DISEASE. 

poisons, after the peculiar action of their respective 
poisons has ceased to act, may become in the same 
manner, mercurial ulcers. But if the poison retains 
its influence in any portion of the ulcer, as soon as 
the mercurial phagedena has subsided, it may in- 
fect the remainder of the ulcer, which will conse- 
quently re-assume its original character. 

4. It occasionally produces pains resembling rheu- 
matism, and swellings of the joints, particularly when 
the patient exposes himself to cold. 

5. It is asserted to be capable of producing nodes, 
which resemble the syphilitic ; but this I doubt, be- 
cause there is no authenticated instance of nodes of 
the bones occurring under courses of mercury for 
any diseases except venereal. 

6. It produces two affections of the constitution; 
the mercurial eruption, and mercurial erethismus, 
which, unlike its usual and characteristic effects, are 
evidently owing to some peculiarity of constitution. 
In the same manner, most medicines, and many of 
our common aliments, produce phenomena in some 
constitutions, attended with great disorder of the 
system, totally different from their accustomed and 
well known effects. 

7. Mercury, and more particularly a mercurial 
atmosphere, are iu the highest degree prejudicial 
and dangerous to patients labouring under any pul- 
monary affection, by producing a rapid state of ex- 
citement, and consequent effusion into the lungs or 
chest* 

*The ill effects of mercury upon the system, may be prevented, 
or greatly lessened, if a free vent or discharge is maintained 



SCALY VENEREAL DISEASE. ' 315 

When I commenced my inquiries, with respect 
to the treatment of venereal diseases, so universal 
was the use of mercury, that the utmost stretch I 
could allow my imagination, was merely to entertain 
a suspicion that these numerous symptoms, which 
did not correspond to Hunter's well known descrip- 
tion of syphilis, might possibly recover without the 
use of mercury : and this, both the friends and ad- 
versaries of my practice will acknowledge was a 
tolerably bold step, at a time that every venereal 
symptom, except gonorrhoea, was doomed to under- 
go a full course of mercury. 

In some recent publications, however, we are 
taught that every form of venereal complaint, in- 
cluding syphilis itself, has been successfully treated 
without the use of mercury. Mr. Rose is particu- 
larly explicit on this point; and in support of his 
opinion, details several cases of primary ulcers, pos- 
sessing the surrounding callosity, and other charac- 
teristics of chancre which were cured without mer- 
cury.* Mr. Guthrie is also equally decisive, but 
does not detail the instances ; his words are, "Every 
kind of ulcer of the genitals, of whatever form or 
appearance, is curable without mercury. This I 

through some of the emunctories, which in this case, as in many 
disorders, act the part of safety valves. It is no great matter 
which of these is selected ; but the skin and kidneys are in gene- 
ral the most convenient. Salivation ought, we think, at all times 
to be carefully avoided, as it is-most frequently attended with great 
inconvenience, and unpleasant consequences, \vithout having any 
thing specific in its operation. The salivary secretion should, if 
possible, always be preserved from vitiation, as it mixes with the 
food and drink, with which it goes into the stomach, and when the 
product of morbid action, doubtless ter^ds to increase the depravity 
of the sj^stem. E. 

* See particularly his 2d, 4th., Gth, 7th, and 8th cas.es. 



3|i SCALY VENEREAL DISEASE. 

consider to be established as a fact, from the obser- 
vation of more than five hundred cases which I am 
acquainted with, exclusive of those treated in the 
different regiments of guards, and which occurred 
in consequence of promiscuous intercourse/'t 

Since those pubHcations fell into my hands, I 
have been anxious to ascertain, by personal obser- 
vation, whether true syphilitic chancres did really 
admit of being cured without mercury ; but this dis- 
ease, as described by Hunter, has diminished in so 
extraordinary a degree in this country, that strange 
to say, I have not from that period met with more 
than half a dozen cases of true chancre, thousjh. 
without adverting to my private practice, my op- 
portunities, as surgeon to an extensive hospital, are 
by no means inconsiderable. I am certain that 
others are more easily satisfied than I am with re- 
spect to the characters of chancre ; but adhering 
strictly to the definition of Hunter, I do not consi- 
der any primary ulcer to be syphilitic which does 
not possess the callous edge and base, terminating 
abruptly under the skin, and feeling nearlv as hard 
as a piece of cartilage. There are ver^' few ulcers 
of an irritable nature which have not some degree 
of fullness around them, which induces many to pro- 
nounce them chancres ; but this fullness is very dis- 
tinct from that callosity which Hunter, and tliC ear- 
ly writers on syphilis, describe. 

However, in consequence of the respectable au- 
thorities mentioned, as well as that of Dr. Thomp- 

t Mr. Guthrie's paper on the treatment of the Tenereal disease 
without mercurv. Med. Chirur2". TransaciioD?. r Tiij n. ir.p. 



SCALY VENEREAL DISEASE. 317 

son, Mr. Ilennen, and others, I determined to seize 
upon the first opportunity of affording ocular de- 
monstration, whether true syphilis, like the other 
forms of venereal diseases, were capable of being 
cured without the aid of mercury ; and I have had 
sufficient proofs, though few, to convince me that 
syphilis, as well as the others, is capable of being 
cured without mercury. 

But it does not by any means follow that there- 
fore the non-mercurial is the most judicious mode 
of treatment; for in the cases thus treated which 
have come to my knowledge, the recovery has been 
remarkably slow, both from the primary as well as 
constitutional affections. And on the contrary, as 
far as my experience extends, the recovery is cer- 
tain and rapid, where mercury is exhibited for the 
symptoms which I have detailed as belonging to 
true syphilis. I have only met with the two follow- 
ing cases of syphilis exhibiting the constitutional 
symptoms, which afforded me an opportunity of 
trying the non-mercurial treatment. 

Case 53. — James Murray, admitted May 20th, 
1818, with an undurated chancre situated at the 
junction of the prepuce with the corona glandis. 
The surface was covered with a small crust, but the 
callosity was of that remarkable kind that termi- 
nates abruptly, and feels like a piece of hard carti- 
lage under the skin. He had also the psoriasis sy- 
philitica in distinct patches, each about the size of 
a sixpence, scattered over his back, breast, forehead, 
arms, &c. 

According to his statement, the ulcer appeared 



318 SCALY VENEREAL DISEASE. 

three months previous to his admission, but had in 
a great measure healed in a month after its appear- 
ance without the use of medicine, leaving, however, 
behind it the callosity, which was constantly cover- 
ed with a small crust already mentioned. He add- 
ed, that six weeks afterwards the eruption began 
to appear, and that he had taken onl}'^ nine mercu- 
rial pills, which did not affect his mouth. 

From the time of his admission until the 15th of 
June, a period of 26 days, no medicine whatsoever 
was given to him, during which the callous substance 
increased in size, and the eruption became more ex- 
tended by the addition of new spots, and the en- 
largement of those that had first formed. Finding 
that the disease was not yielding to the powers of 
the constitution, I determined to make a trial of 
sarsaparilla, the decoction of which was ordered for 
him, with a drachm of the powder thrice a day. 
Shortly after the exhibition of this medicine the 
callosity began to decline, and so early as the 5th 
of July, it was noted that the callosity had consi- 
derably lessened, and the eruption was of a paler 
colour. 

July 20th. — The ^ruption had nearly declined, 
but there still remained some induration in the seat 
of the chancre. At this period he thought proper to 
quit the hospital without leave. 

However, on the 4th of August he applied again 
for admission ; the eruption had increased, and the 
callosity of the penis still remained. He was or- 
dered the decoction and the powder of sarsaparilla 
as before, which he continued to take until the 28th 



SCALY VENEREAL DISEASE. 



319 



of September following, at which time the eruption 
had disappeared, and the callosity dispersed. He 
was discharged apparently well : on the 10th of No- 
vember following he again came to the hospital on 
account of some faint spots of the psoriasis syphili- 
tica on his back and arms ; and several small super- 
ficial ulcerations on the scrotum. It was not thought 
necessary to receive him into the hospital on ac- 
count of these trifling symptoms ; but he was desir- 
ed to return if any aggravation of his complaints 
should take place. He, however, did not afterwards 
apply at the hospital. 

Case 54. — The other case of syphilis treated 
without mercury, was that of Edward O^Brien, who 
was admitted into the hospital on the 24th of May 
1818. At this time there was a large ulcer extend- 
ing along the dorsum of the penis, from the prepuce 
almost to the pubis. It was of a livid colour and in 
every respect corresponded with the description of 
chancre on the body of the penis. 

June 1st. — The ulcer had extended, and its sur- 
face had changed from a livid to a tawny colour ; 
but in a few days afterwards, the same livid appear- 
ance returned. 

8th. — He began to complain of pains in his shoul- 
ders, arms, knees, and tibiae. The pain in the lat^ 
ter afterwards became extremely acute, and he 
could not bear the slightest pressure on those bones. 
He lost his rest and became emaciated. On the 16th 
of June, the pain and tenderness of the tibia? were 
so ver}' acute, as were also those in his joints, and 
particularly in his hands and wrists, and the enip- 



32() SCALY VENEREAL DISEASE. 

tion had so far extended, that I conceived that mer- 
cury was absolutely necessary for this individual ; 
and I was disposed to order it on the instant : and 
in this opinion a most attentive and intelligent class 
of pupils who watched this, as well as all the other 
venereal cases, with the greatest assiduity, seemed 
anxiously to concur; I am now, however, well pleas- 
ed that I postponed this intention, and determined 
upon giving a trial, in the first instance, to sarsa- 
parilla ; although I confess, at the time I had little 
or no hopes of succeeding by its means. I direct- 
ed it in the form of powder and decoction in fulL 
doses. 

On the 28th, however, to my surprise, a very re- 
markable amendment was apparent in all his com- 
plaints. The ulcer looked healthy in the middle, and 
had ceased to extend. The pains and tenderness 
of the tibiae were diminished, and the eruption was 
obviously on the wane. From this period his 
amendment was regular and decided ; the eruption 
and pains had entirely declined before the 14th of 
July, and the ulcer had healed to one-half its former 
size. His countenance and general appearance 
were at the same time improved. But at this very 
juncture, when the ulcer was healing rapidl}'^, by 
some imprudence, he excited inflammation, and a 
partial paraphymosis. 

He was again directed to confine himself to bed 
and to poultice the penis with bread and water. In 
a few days the inflam.mation was dispersed, and the 
ulcer progressively amended, but was not healed 
until the 8th of August. He was discharged per- 
fectly ^Vell on the 13th of the same month. 



SCALY VENEREAL DISEASE. 321 

Although these two cases cannot fail to make a 
due impression, yet if they stood alone, their evi- 
dence could not be deemed sufficient to establish a 
belief that true syphilis, like the papular disease, is 
capable of yielding to the powers of the constitution, 
or to remedies in which mercury does not form an 
ingredient. But this deficiency is amply supplied 
by the testimony of Messrs. Guthrie, Rose, Hennen, 
Dr. Thompson, and other equally intelligent sur- 
geons. 

It must be admitted, however, from these cases, 
that although mercury may not be absolutely ne- 
cessary for the cure of true syphilis, yet that recov- 
ery may be greatly expedited by the exhibition of 
that medicine. 

In thus relinquishing my opinion, that true syphi- 
lis differs from other venereal complaints, by always 
requiring mercury for its cure, it is necessary to 
reduce the doctrine I hold to this proposition ; that 
with respect to the use of that medicine, it differs 
from them only in not being injured, but decidedly 
benefitted, by it in all its symptoms and stages. I 
may not soon have an opportunity of advancing this 
investigation much farther on account of the extra- 
ordinary fact already adverted to, that syphilis is 
now comparativel}' seldom to be found in this coun- 
try, although the verj^ form of venereal disease, 
which, there is reason to believe, was most predom- 
inant in the time of Hunter. A few years back, 
and particularly in 1812 and 1813, that malignant 
attendant of the phagedenic disease, the sloughing 
ulcer, was extremely prevalent in Dublin; but I 

2s 



32^ SCALif VENEREAL DISEASE. 

have only seen it in one or two cases either in private 
or public practice, during the last six years. It may 
therefore be considered as far from improbable, that 
there are prevailing forms of venereal affections, 
like prevailing epidemics, at different times and in 
different countries — a circumstance that may possi- 
bly depend on the importation of fresh infections; 
although these arrivals are seldoQi recorded with 
the same notoriety as that of syphilis from St. Do- 
mingo.^ 

This hitherto unnoticed phenomenon may serve 
to explain the universal adoption of mercury for 
every form of venereal disorder ; for when syphilis 
became the prevalent malady, the reputation of mer- 
cury must have greatly increased, and its utility at 
once been acknowledged and exaggerated. But we 
have seen that although this medicine is injurious 
in the commencement of the papular, pustular, and 
phagedenic diseases, yet Avhen they are on the de- 
cline, and their eruptions have become scaly, and 
bear some resemblance to the syphilitic eruption, 
its exhibition in this stage of the disorder often ope- 
rates like magic, in bringing a lingering disease to 
a quick and favourable termination ; and when all 

* That the forms of the venereal disease are often influenced by 
epidemic causes, the editor was induced to believe from his own 
observation, long before he was furnished with a hint of the cir- 
cumstance from any other source. He has frequently noticed 
that, during certain periods, nearly all the cases under his treat- 
ment, were of the same nature ; whilst, at other times, different 
forms have prevailed. These variations may have depended upon 
accidental circumstances; but their frequent occurrence has cer- 
tainly led to a different conclusion. In another part of this work, 
the author has adverted to this subject still more pointedly. E. 



SCALY VENEREAL DISEASE. 323 

tliese diseases were treated alike, it is no wonder it 
should soon be forgotten that there was any distinc- 
tion between them, or in fact that there was any 
other venereal disease besides syphilis. These cir- 
cumstances were of a nature to hood-wink and mis- 
lead the majority of the profession, and establish 
the practice which has so widely and absurdly pre- 
vailed. Yet early and at all times there existed a 
few clear-sighted and discerning individuals who 
perceived the mischiefs attendant upon the indis- 
criminate employment of this powerful drug; and 
who were not contented with the expedient of in- 
venting names to delude themselves and their pa- 
tients, and ingeniously satisfy their consciences 
while committing, through the medium of this medi- 
cine, the most unwarrantable depredations upon the 
constitutions and lives of those who confided them 
without reserve to the disposal of their judgment. 



CHAPTER VII. 

DISEASES 3I0ST LIKELY TO BE CONFOUNDED WITH THOSE 
OF VENEREAL ORIGIN.^SYNOFSIS OF THE WORK. 

The genital organs are of course liable, in com- 
mon with all tlie other parts of the body, to phleg- 
monous inflammation and its consequences : to erysi- 
pelas, anthrax, &c. In addition to these the pre- 
puce is subject to a peculiar vesicular eruption, 
which from irritation often extends into sores that 
are frequently confounded with venereal ulcers- 
This eruption is termed herpes preputialis. 

Phlegmonous inflammation of the penis, which 
does not arise from external injury, almost always 
terminates in suppuration, notwithstanding every 
effort made to procure resolution ; therefore, gene- 
rally speaking, it is the better practice to encourage 
suppuration at once by means of warm poultices, 
and to discharge the matter by a free opening at 
soon as its presence is indicated. 

When phlegmon forms on the prepuce, it is at- 
tended with considerable thickening and induration, 
which remain even after the matter is evacuated; a 
chronic burrowing ulcer often succeeds, which is 
extremely difficult to heal ; and all our eflTorts to 
bring about this ev^ent are in general useless, until 
the sinous ulcer which usualh^ forms, is laid freely 
open. And even this is often unavailing, without 



DISEASES RESiyMBLING VENEREAL. 325 

a removal of a portion of the indurated integument, 
which may be either done with the knife or com- 
mon caustic ; but the former, as least painful, is to 
be preferred. When this is once accomplished, the 
part usually heals without farther difficulty. Wo- 
men are also liable to be affected with painful 
abscesses, which form within the labia, perineum or 
sides of the vagina. They are generall}^, as well 
during their formation as afterwards, attended with 
considerable pain; and often in married women great 
mental uneasiness is occasioned, under an appre- 
hension that they are of venereal origin. 

As soon as matter is perceived, a free opening 
gives immediate relief, and the part usually heals 
afterwards without difficulty. Sometimes, however, 
sinuses take place which are tedious, and must be 
treated according to the general principles of sur- 
gery, before they can be induced to heal. From 
the protracted and tedious nature of those sinous 
ulcers in both sexes, we may readily conceive what 
mischief must ensue, if they should be mistaken for 
venereal ulcers, and that course after course of mer- 
cury be exhibited, until the constitution of the pa- 
tient is irretrievabl}^ ruined; such instances I regret 
to observe, have often fallen under my observ ation. 

Erj'sipelatous inflammation of the penis I have 
only seen as an attendant upon a foul irritable ulcer ; 
therefore it is unnecessary to treat of it as a distinct 
affection : neitlier have I ever w^itnessed the pre- 
sence of anthrax on this part ; but as there is no 
reason why the penis should not be as liable to this 
affection as any other part of the body, we ought 



326 DISEASES LIKELY TO BE 

to be prepared to encounter it. Mr. Evans states, 
that he has frequently witnessed the circumstance, 
and giv^s two cases in illustration. The repeated 
returns of sloughing in his first case, however, ap- 
pears to be unlike what is observable in anthrax in 
other parts of the body. The reader will do well 
to consult his work upon the subject.* 

Herpes preputialis is a very common affection. 
On the external prepuce it usually occurs in the 
form of a cluster of four or five vesicles, which soon 
scab and heal in a few days, if not irritated by the 
friction of the patient's clothes, or the improper ap- 
plication of stimulating or caustic washes. On the 
inner surface of the prepuce, owing perhaps to the 
moisture of the part, we seldom have an opportu- 
nity of seeing the vesicles, which pass into minute 
circular ulcers that often run into each other. All 
that is required to cure this trifling complaint is the 
prevention of irritation. When it occurs on the in- 
ternal surface of the prepuce, it may be well to in- 
terpose a bit of dry lint, as the secretions of the part 
are in such instances usually acrimonious, and may 
possibly have occasioned the complaint. The di- 
agnosis between this affection and venereal ulcers, 
when the former occurs on the external prepuce, 
is obvious, — the cluster of vesicles sufficiently point 
out its nature. But if it has been irritated, so as to 
produce ulceration, or when this takes place on the 
internal surface of the prepuce, we must wait until 

* See Evans's Remarks on Ulceration of the Genital Oi^ns. 
p. 12 to 22, 



CONFOUNDED WITH VENEREAL. 327 

time develops its true nature, before we can ven- 
ture to give a decided opinion* 

I have met with eight or ten cases of ulcers situ- 
ated either on the groins, pubes, or scrotum and 
fossa of the nates, or on all these parts at once in 
the same individual, which resemble, in their raised 
edges and obstinate nature, the primary ulcers of 
the pustular venereal disease. These ulcers exist 
in distinct patches, and have a zig-zag appearance. 
They creep on slowly, with margins both raised 
and undermined. I know not whether we ought 
to consider them as venereal ; but place them in 
this section of my work until their origin is deter- 
mined. 

In all the cases of this description, a large quan- 
tity of mercury had been used ; so that we might 
be inclined to consider them as mercurial, if such 
ulcers were ever observed to arise from the exhibi- 
tion of mercury for any diseases that were not ve- 
nereal. Under every mode of treatment they are 

* For want of proper discrimination and experience, this affection 
has often received the treatment applicable only to the most 
virulent syphilitic affections. The editor has seen many instances 
of its occurring to married men, with an aspect well calculated to 
alarm such as are unacquainted with its character. It is most 
common to those in whom the prepuce covers a considerable por- 
tion of the glans, and where the secretions from those parts are 
greater than ordinary. 

A lotion of lime water, or solution of white vitriol, will often 
cure it very speedily : but sometimes it disappears and soon re- 
turns, so as to prove, by repeated recurrence, very troublesome to 
the patient and his physician. When the curative means already 
recommended are not found sulGficient, advantage may result from 
dusting the parts affected, with a powder consisling of equal por- 
tions of calomel and arrow root, confined in a gauze or cambric 
bag. Frequent ablution should never be neglected by those sub- 
ject to or labouring under this affection. E. 



328 DISEASES LIKEJLY TO BE 

obstinate. Caustic and irritating applications are 
always injurious. The patient often recovers under 
sarsaparilla, country air. and sea-bathing; but it is 
not easy to decide whether these means are instru- 
mental to his recovery. 

One of my private patients was affected two years 
with ulcers of this description, which had spread 
over the groin, fold of the thigh, pubes, and lower 
part of the abdomen. He had been in the hands of 
several professional men, but at length the obstina- 
c}^ of these ulcers yielded to the exhibition of Fowl- 
ers solution of arsenic, and pressure upon the dis- 
eased part by means of adhesive straps and ban- 
dages, according to Baynton's method, with the ex- 
ception, that in place of diachylon, the straps were 
spread with equal parts of soap and strengthening 
plaister, which excites less irritation of the skin 
than the former. For this hint I am indebted to 
Mr. Young, who, it is well known, employs this com- 
position in cancerous cases. 

Different complaints are also frequently met with 
besides those mentioned in my first chapter, which 
bear a close resemblance to the constitutional symp- 
toms of venereal diseases, particularly to those of 
the phagedenic disease, and yet cannot be traced to 
a venereal origin. This subject has been already 
so ablv considered bv JMr. x\bernethv, that Jittle re- 
mains for me. except to add my suffrage to the doc- 
trines he has enforced. In ^\es\ instance in which 
constitutional affections occur that are liable to be 
mistaken for those of venereal diseases, but cannot 
be traced to anv infection, it universally happens. 



CONFOUNDED WITH VENEREAL. 329 

that the patient has been previously, for a consider- 
able time, disordered in his health; his digestion is 
bad, and he feels himself dispirited and unwell, 
without being able to point out any particular ail- 
ment as the cause of his indisposition. 

On another occasion,^ I have adduced incontro- 
vertible facts, which demonstrate, that disorder of 
the chylipoetic viscera precedes and accompanies 
the symptoms of scrofula, and that there are the 
strongest grounds for believing that such disorder 
is, in a very great majority of cases, the immediate 
cause of the disease. A defective digestion, con- 
tinued for any length of time, must as certainly pro- 
duce chyle or blood of a vitiated quality, and unfit 
to replenish the waste of the body, as the constant 
use of unwholesome food, which is undergoing the 
putrefactive or acetous fermentation. A disorder- 
ed state of the system at first ensues, followed by 
various local complaints. Among these are swel- 
lings of the lymphatic glands, which frequently ul- 
cerate, different species of cutaneous affections, 
particularly the tubercular eruption, which likewise 
ulcerates. Ulcers are often . seen in the throat, 
which it is not easy to distinguish from those of ve- 
nereal orgin ; and, lastly, ulceration of the pituitary 
membrane is very frequent, attended with caries of 
the bones, of the nose and palate, and often with 
fistula lachrymalis. Even the deep-seated parts do 
not escape ; for the patient complains of pains in 
the joints, which are often mistaken for those of 

* See my Essay on Scrofula. 
2 T 



330 DISEASES LIKELY TO BE 

chronic rheumatism ; and affections of the bones or 
their coverings, producing a kind of node, are not 
unfrequent. In fact this train of symptoms occurs 
ever}^ day under our eyes, in children, whose youth 
fortunately protects them from the suspicion which 
lights on their elders ; for it is by no means unusual 
to find in scrofulous children ulcers which arise from 
tubercles, and also ulcers of the tonsils, nodes on 
the shins, and pains in the joints, which, if they oc- 
curred ^at a more advanced period of life, would in- 
evitably condemn them in the hands of a great ma- 
jority of practitioners to a severe course of mer- 
cury. 

In these countries, almost every chronic complaint 
which cannot otherways be accounted for, is sus- 
pected to be a symptom of latent venereal disease ; 
and it is in vain for the unfortunate patient to pro- 
test his innocence, if one or two of the train of symp- 
toms I have stated, concur to satisfy his medical at- 
tendant of the incredibility of his assertions ; whose 
doubts, if he had any, are completely dissipated by 
the favourable change which almost always ensues 
on the first exhibition of mercur}\ The patient 
cannot withstand this accumulation of evidence, 
and begins to think that the remnant of some old 
venereal taint has been lurking in his system for a 
long series of years ; or that the poison may have 
been imbibed by drinking out of the same cup with 
an infected person, or caught in some accidental 
w^ay, that he can neither describe nor account for. 
But the opinions of friends are seldom so lenient, 
and many a happy family has been plunged into 



CONFOUNDED WITH VENEREAL. 331 

the deepest distress by the unqualified and unjust^ 
fiable sentence of a practitioner, who can not rise 
above his prejudices, or conceive that symptoms in 
any degree resembling the venereal, can originate 
from any other than a venereal poison. 

It is chiefly by an attentive consideration of the 
history of those cases, the state of general health of 
the patient previous to the occurrence of local dis* 
ease, and the non-appearance of primary symptoms, 
that we are enabled to form a just judgment on the 
nature of the disease. They often bear so clos^ a 
resemblance to complaints of venereal origin, that 
it may be well to impress the circumstance the 
more strongly on the minds of my junior readers by 
the illustration of two or three instances. 

Case 55.— In the winter of 1810, a gentleman 
consulted me on account of a complaint which he 
supposed to be a commencing fistula lachrymali$. 
One of his eyes continually watered, and on exami- 
nation, the bones of his nose felt enlarged, and were 
tender when pressed. He snuffled also very much, 
and breathed with difficulty through his nose* He 
mentioned, accidentally, that he felt a soreness for 
a few days in his palate; on examination, I perceiv^ 
ed a round hole, about the size of a pea, in the pa- 
late, through w^hich the probe passed readily into 
the nose. There w^as an ulcer of the same appear- 
ance, but somewhat larger, covered with white vis- 
cid matter, on the soft palate, just above the velum. 

I immediatel}' suspected syphilis, but he posi- 
tively denied having had any venereal complaint 
§ince he w^as married, a period of nine years, during 



33^2 DISEASES LIKELY TO BE 

which time he had seven children, who were all 
healthy from their birth. His wife was also per- 
fectly healthy. This gentleman had not enjoyed 
good health for the two years previous to his ap- 
plication to me. He felt himself unwell without 
being able to ascertain the cause, and was affected 
with an unaccountable lowness of spirits. He was 
afterwards attacked with pains in his joints, which 
were treated by a physician of the first eminence 
as rheumatic. His tongue was furred, his sleep 
disturbed at night, and by day he felt himself inca- 
pable of attending to any thing which required in- 
tellectual exertion. 

I gave him my opinion that a course of mercury 
would be necessary to remove the disorder, whe- 
ther or not it proceeded from a venereal infection. 
This advice was thought so extraordinary, that my 
patient would not submit to so severe a remedy, 
without the opinion of another surgeon. Mr. 
Richards was consulted, and he agreed with me in 
the propriety of a mercurial course, although we had 
no facts to lead us to suppose that the patient had 
been affected with syphilis during the preceding ten 
years : except the appearances I have described. 
In a week after the commencement of mercury, the 
ulcers were completely healed, but the opening in 
the palate bone did not close. The tenderness of 
the bones of the nose, and the disposition to fistula 
lachryiiialis, were also removed. The course of 
mercury was, however, persevered in for two 
months, during which period he rubbed in eight 
ounces of ointment, which sustained for almost all 



CONFOUNDED WITH VE^SEREAL. 333 

that time a full mercurial action. He has since re- 
mained perfectly well. 

If a similar case was to occur to me at present, 
my reader is by this time satisfied that I should 
deem it sufficient to give mercury in alterative 
doses, conjoined with the simple or compound de- 
coction of sarsaparilla.* The following case was so 
treated. 

Case 56. — On the 12th of June, 1815, 1 was call- 
ed upon to see a young unmarried lady, whose con- 
dition and morals placed her altogether beyond the 
reach of suspicion ; yet the symptoms with which 
she was affected precisely resembled those which 
are undoubtedly of venereal origin. There was a 
considerable number of large tubercles similar to 
those described in the last chapter, scattered over 
her legs, arms, and thighs, attended with discolour- 
ation of the integuments. She complained of sorer 
ness of her throat ; and on examination, I found the 
back of the pharynx ulcerated and covered with 
white tenacious matter, evincing a similar corre- 
spondence between the affection of the skin and 
throat to that which I had often witnessed in ve- 
nereal cases. Her tongue was white and furred, 
with bad appetite and general derangement of the 
system. 

I merely regulated her diet, ordered five grains 
of blue pill every night, and three drachms of sul- 



* Mr. Abernethy gives a case perfectly analogous to this, in sup- 
port of similar opinion, of which he has the merit of being the 
first promulgator. See Abernethy on Diseases resembiing Syphi- 
lis, page 80, 



334 DISEASES LIKELY TO BE 

phat of magnesia every morning, under ^vhich plan 
she had perfectly recovered before the 12th of July 
following, when I ceased to visit her. 

I might adduce many instances of similar tuber- 
cles terminating in ulceration in children, in whom 
they are generally esteemed to be the signs of a 
strongly marked scrofulous constitution, and cannot 
be suspected to be venereal complaints, because 
they occur too late after birth to be ascribed to a 
venereal taint derived from the parents ; and too 
early in life to be visited as an imputation on the 
young patients themselves. But by whatever name 
the disease may be called, it is in children, as well 
as in adults, accompanied by general derangement 
of the constitution ; and vields in both to the same 
inode of treatment, viz. small alterative doses of 
mercury, conjoined with decoction of sarsaparilla. 

I shall only add two other cases in illustration of 
the constitutional diseases which are liable to be 
mistaken for those of venereal origin. 

Case .57. — John Larkin, a very young man, ad- 
mitted July 3d, 1816, with an extensive phagedenic 
ulcer of the throat, engaging the velum, tonsils, and 
back of the pharynx. The entire uvula and a con- 
siderable portion of the velum and tonsils had been 
destroyed by the disease, and he complained of se- 
vere head-ach and deafness. 

According to his statement, the ulcer commenced 
about six months previous to his admission, with- 
out his having had any primary affection, and he 
persisted in affirming that he never had sexual con- 
nexion in his life. He also stated that the practi- 



CONFOONDED WITH VENEREAt. 335 

tioner whom he had consulted, did not appear to 
believe his assertions, as he put him through two 
severe mercurial courses, which, however, did not 
produce any beneficial effects upon his throat. 

I directed for him the decoction of sarsaparilla, 
antimonial solution, and the following lotion, with 
which the ulcer of his throat was touched every 
third hour. 

R. Muriatis Hydrarg. cor. (sp. vini. solut.) gr. sex. 

Aquae, distillatse unciam cum semisse. 

Mellis despumati semiunciam. 

Under this plan immediate amendment ensued ; 
the ulcer was healed before the 28th, and he was 
discharged the hospital on the 3d of August. 

Case 58.— On the 8th of July, 1816, 1 saw Cap- 
tain S. in consultation with Doctor Little, of Tuam, 
on account of a disease of the bones of the nose, at- 
tended with a most offensive discharge. The car- 
tilage of the nose was much depressed in conse- 
quence of the want of its usual support, owing to 
the destruction of the vomer and perpendicular car- 
tilage attached to it. The greater part of the spongy 
bones were also destroyed; and on examination 
with a probe, all the bones forming the walls of the 
cavity of the nose felt rough and carious. — The 
commencement of this complaint occurred, as he 
stated, near two years previous to his application 
to me, and took place at a period when his bodily 
health and strength were greatly reduced by most 
fatiguing military duties, and an intermittent fever, 
caught in the marshy parts of Canada. He stated 
in the most positive manner that he had not been 



336 DISEASES LIKELY TO Bft 

affected for as long a period as fifteen or sixteen 
years before with any venereal complaint, an asse- 
veration which the surgeon of his regiment seemed 
not to regard with much attention, as he put him 
through several severe courses of mercury, which 
reduced him to the lowest extremity, without pro- 
ducing any amendment of his complaints ; on the 
contrary, he always felt himself worse when mer- 
curially affected, and during the use of that medi- 
cine, extensive exfoliations occurred. When leaving 
Canada, he was so much enfeebled that he was 
carried into the vessel; but during the voyage and 
after his return to Europe, he rapidly regained his 
strength. 

Large exfoliations, engaging portions of the bones 
of the nose, palate, and upper jaw, continued to 
come away, from time to time, for the next ten 
months, during which period several medical men 
were consulted and a variety of remedies were em- 
ployed. Attention to cleanliness and country air 
seemed, however, to be the only means from which 
he derived any advantage. At length intense head- 
achs, and a tendency to delirium at night, made 
me suspicious that the disease had extended to the 
bones which supported the brain, and affected that 
organ. 

On the 14th of June, 1817, 1 was called upon to 
see him. — His manner was quick and irritable, pulse 
1 12, tongue furred. He complained of a distract- 
ing head-ach and intolerance of light. General and 
local blood-letting was resorted to, and the exhibi- 
tion of active purgatives. — On the 16th his pulse 



CONCLUDLXG OBSERVATIONS. 337 

was 120, and he lay comatose. In the evening con- 
vulsions set in, and he died a few hours afterwards. 
. On examination of the head, the vessels appear- 
ed remarkably turgid; and coagulable lymph was 
found in a greater degree than is usual even in in- 
flammatory infections of the head, effused over the 
pia matter. On cutting through the right anterior 
lobe of the brain, it presented a yellow tallow-like 
appearance, and was of a very soft consistence; and 
on penetrating deeper, near to its lower surface 
where it lay on the orbitar plate, an abscess was 
found about the size of a walnut, containing a tena- 
cious, turbid, flaky fluid of the colour of pus. The 
cribriform lamella of the sethmoid bone was com- 
pletely carious, and adjoining this the right orbitar 
plate of the frontal bone upon which the abscess 
lay, presented a yellow unsound appearance. The 
ventricles were filled with a fluid similar to that 
contained in the abscess, and there was a large quan- 
tity of the same matter accumulated about the me- 
dulla oblongata. It appeared to make its way by the 
fourth ventricle, and to have also passed into the 
sheath of the spinal marrow. 

Persons of judgment and discrimination will know 
how to estimate the value of the cases detailed in 
this work, because the great majority of them rela- 
ted to persons in a humble sphere of life. Those 
who seek an asylum in hospitals aflbrd better ex- 
amples of the progress of diseases, and the effects 
of remedies upon them, than the cases of private 
practice. This is more particularly observable in 

2 u 



•^38 CONCLUDING OBSERVATIONS. 

the maladies under consideration. In the mode of 
practice for so many years prevalent, as soon as a 
private patient had undergone a severe course of 
mercury, without amendment, and that his medical 
attendant, seeing the inutility of a farther perseve- 
rance in that medicine, laid it aside, he usually 
sought the advice of a second professional man, who 
perceiving that a sufficient quantity of mercury had 
not been exhibited, put his patient through another 
course. The disease still gaining ground, a third, 
or a fourth was consulted, till at length he ran the 
gauntlet through the greater part of the profession, 
each practitioner inflicting on him his own favourite 
mode of administering his specific. At last the un- 
fortunate patient, with broken constitution, spirit, 
and resources, possibly returned to the advice of his 
first attendant, with regret that he ever sought any 
other. But it is not from him, or those of our fra- 
ternity who were most familiar with his symptoms, 
that it is now possible to obtain a satisfactory his- 
tory of his complaint, except in a single point— the 
inefficacy of repeated courses of mercury for its re- 
moval. Therefore, I say, it is only from the regis- 
try of a hospital that we can gain a faithful account 
of the symptoms and progress of these obstinate 
diseases, where the patient is restricted to the regi- 
men and medicine prescribed by the surgeon of his 
ward, and not allowed to indulge his own fancy and 
caprice in wandering from one practitioner to ano- 
ther, or in employing in a clandestine manner, means 
not known to his medical attendants. But as al- 
most all our registered experience of venereal dis- 



CONCLUDING OBSERVATIONS. 339 

eases seems to be taken from private practice, we 
should not be surprised at finding that the promi- 
nent facts stated in this work are not to be found in 
other publications on the subject: orif they are hint- 
ed at, that they should, either from preconceived 
opinions, be distorted, overlooked, or laid at the 
door of the remedy so long and so pertinaciously 
exhibited without benefit. — Thus both the acute 
and the lingering pains in the joints, are very gene- 
rally ascribed to mercury, and not to a venereal 
virus ; and even a modern author, who has written 
expressly on the subject, has attributed to the ex- 
cessive use of this medicine, eruptions, ulcers on the 
skin and throat, and nodes on the bones. A mis- 
take we cannot be surprised at, when we recollect 
how lavishly it is used in those venereal diseases 
which do not yield to its influence ; and the frequent 
appearance of these symptoms, while the patient is 
suffering the most severe salivation. 

The variety of venereal appearances, and the 
modification and change which they are perpetual- 
ly undergoing, together with the fact, that these 
maladies are not exactly alike in any two countries ; 
and the consequent frequent introduction of new 
symptoms, by m.eans of foreign infection, require 
that we should be always on the watch, with a view 
to ascertain the nature of the most prevailing vene- 
real complaints ; for I have constantly observed that 
there is a predominant infection for a season, which 
in general, on the succeeding, gives way to an- 
other. 

It may be considered a strong corroboration of 



340 



CONCLUDING OBSERVATIONS. 



the opinions supported in this treatise, that relapses 
were far more frequent in all venereal diseases (the 
scaly or vSyphilitic excepted,) when mercury had 
been used, than when they were treated exclusive^ 
ly, by the other means recommended. And in clos- 
ing these pages I have the gratification of stating, 
that after several years of observation and scrutiny, 
during which, the symptoms and progress of these 
diseases were constantly and carefully watched and 
followed, I have not met with any circumstance 
to induce me to doubt the principles I have endeav- 
oured to enforce in the course of this work. 

Having now brought this complicated subject to 
a close, and endeavoured to put in order a numer- 
ous class of symptoms, which it has been often said 
bid defiance to any system of arrangement, it may 
be well, in concluding the work, to present them to 
the understanding of my reader according to 'their 
classification, detailed in a tabular form ; and I shall 
only remark, that a classification of venereal com- 
plaints, grounded on the character of the eruption, is 
not only the most natural, and most in accordance to 
the pathological arrangement of other eruptive dis- 
eases attended with fever, but it is also, in a practi- 
cal point of view, the most useful that can be de- 
vised ; — for the general tendency of the disease, 
either with respect to mildness, severity or duration, 
may be anticipated by the character of the erup- 
tion. 



SYNOPSIS. 
I. 

PAPULAR VENEREAL DISEASE. 



Primary Symptoms, 

l.The simple primary ulcer, 

2. Patchy excoriation, attend- 
ed with a discharge, 

3. GonorrhcEa virulenta, 



4. Buboes, 



R'emedies. 

Astringent washes. 

Antimonials. 

Purgatives. 

Astringent washes. 

Antimonials. 

Terebinthinates. 

Leeches. 

Cold applications. 

Blisters. 

Poultices. 



Secondary Symptoms, 
1. Papular eruption, preceded 
by fever, and ending in 
desquamation, 



2. ^rithematous inflamma- 
tions of the fauces, 



3. Swelling of the tonsils and 
glands of the neck, 

4. Pains in the larger joints 
resembling rheumatism. 



5. Iritis, 



General blood-letting to be 
adopted when indicated by 
the fever, and proportioned to 
its degree. 
Antimonials. 
Sarsaparilla. 

I Mercury unnecessary in any 
^ stage ; and highly injurious un- 
til the eruption desquamates,, the 
fever is subdued^ and the disor- 
der is evidently on the wane; 
and then an alterative course of 
antimony and calomel may oc- 
casionally accelerate the cure, 

[Full mercurial affection of the 
j system until the inflammation is 
-^ subdued. 
i Local bleeding, 
l^ Blistering. 



342 



STNOPSIS. 
II. 



PUSTULAR VENEREAL DISEASE. 



Primary Symptoms. 

I. The ulcer with elevated 
edges, without induration. 



2. Buboes. 



Secondary Symptoms, 

, Eruption of pustules in ge- 
neral phlyzacious, preced- 
ed by fever, and terminat- 
ing in ulcers covered with 
thin crusts that heal from 
their margins, and when the 
disease is on the wane, the 
eruption desquamates into 
scaly red blotches. 



Remedies. 

Astringent washes. 

Antimonials. 

Purgatives, 

The same treatment as for the 
buboes in No. I. 
Excision of the undermined 
edses of the bubo. 

^General blood-letting, as in 
No. I. 

Antimonials. 
Sarsaparilla. 
Guaiacum. 
Tar Ointment. 
Baths of sulphurated kali. 
Sulphureous fumigations. 
Nitro-muriatic acid baths. 



2. Ulcers on different parts of 



Mercury is decidedly pernicious 
until the pustules terminate in 
scaly blotches instead of forming 
Vilcers ; and then mercurials^ in 
alterative doses^ conjoined -with 
sarsaparilla or guaiacum, may 
occasionally he employed v)ith 
benefit. 

The same general treatment, 
conjoined with the following 
local applications : 
Common detergent gargles. 



iv^.o v,w ^ r-"- Lyommon ueiergei 

the fauces, m general o\ . ^^^^^^,[^1 gargles 
a white apthous appear- ^ Qxymel ^ruginis 
ance. Fumigations of Hydrarg. 

Sulphuret. rub. or of Hy 
drarg. cum Creta. 



SYNOPSIS. 



343 



o. Pains in the joints. 



4. Nodes. 



^The same general treatment, 
conjoined with the following 
local applications : 
Leeches. 
Fomentations. 
Bread and water poultices. 
Blisters. 

Ointment of tartarized anti- 
mony. 

Mercury is to be particularly 
avoided while inflammation of 

^the knee exists, 

f The same general treatment, 
conjoined with the following 
local applications : 
Leeches. 

Bread and water poultices. 
Blisters. 
•<J Ointment of tartarized anti- 
mony. 

Division of the periosteum. 
If the preceding remedies prove 
inefficient, mercury may be of 
advantage, provided the general 
^disease is on the zoane* 



344 



SYNOPSIS. 
III. 

PHAGEDENIC VENEREAL DISEASE. 



Primary Symptoms, 



1. The phagedenic ulcer, 



Remedies, 

Bread and water poultices 
with opium occasionally add- 
ed. 

Warm fomentations. 
General blood-letting, propor- 
tioned to the acuteness of pain, 
inflammation, and symptoma- 
"^ tic fever. 

Antimonials in nauseating do- 



2. The sloughing ulcer. 



ses. 

Opium 

Cicuta 

Hyoscyamus 

Purgatives. 



in full doses^. 



3. Buboes. 

Secondary Symptoms, 

1. Eruption of tubercles, or 
spots of a pustular tenden- 
cy, or both intermixed, 
preceded by fever, and ter- 
minating in ulcers covered 
with thick crusts, which of- 
ten assume a conical form, 
healing from their centre, 
and extending with a pha-'< 
gedenic margin. When the 
disease is on the wane, they 
desquamate like those of 
No. II. into scaly red 
blotches. The disease is 
attended with great debili- 
ty, particularly when the 
ulcers are extensive. 



SThe same treatment as for 
buboes, in No. II. 



^General blood-letting, as in 
No. I. and II. 

Antimonials. 
Sarsaparilla. 
Guaiacum. 

Compound powder of ipeca- 
cuanha. 
Opium. 
Cicuta. 
Nitrous acid. 
Nitro-muriatic acid bath. 
Mercury, (imth the exceptions 
noticed helovi) increases the ra- 
vages of the disease in all its 
stases^ but the last. It may then 
be given zcith safety and advan- 
^ tage, as in Xo, II. 



SYNOPSIS. 



345 



Ulcers on different parts of 
the fauces, and particular- 
ly the back of the pharynx, 
frequently engaging the en-<( 
tire fauces, and sometimes 
extending to the larynx and 
nares. 



^The same general treatment, 
conjoined with the following 
local applications: 

Oxymel jEruginis. 

Strong solution of muriate of 
mercury, or nitrate of sil- 
ver. 

Fumigations of Hydrarg. Sul- 
phuret. rub. or of Hydrarg. 
cum Creta. 



If these should prove inefficient, 
mercury may be used largely 
with advantage in checking the 
progress of the ulceration, even 
though it should exasperate the 
^general disease. 



C Caustic issues or applications 

3. Ulceration and thickening ^ of moxa on each side of 

of the larynx. ^ the thyroid cartilage. Tra- 

V cheotomy. 

^The same general treatment, 
with the yellow and black 
mercurial washes frequently 
injected into the nostrils. 

Fumigations of the Hydrarg. 
Sulphuret. rub. or of the Hy- 
drarg. cum Creta through the 
nares. 

If these remedies fail, mercury 
may he used as above* 



4. Ulceration, and caries of , 
the bones of the nose. ^ 



3. Pains of the joints. 



The same treatment as in 
No. II. for the same symp- 
tom. 



6. Nodes. 



( The same 
I No. n. 



treatment as in 



Z X 



346 



SYNOPSIS. 



IV. 



SCALY VENEREAL DISEASE. 



Primary Symptoms, 



Remedies. 



1. The chancre, or 
ulcer. 

2. Buboes. 



(Full courses of mercury for 
callous j hoih primary and constitutional 
\ symptoms.^ except a tendency to 
j phthisis pulmonalis or other de- 
I licacy of constitution should for- 
\hid them. 



Secondary Symptoms. 

' 1. Eruption of scalj blotches, 
presenting either the cha- 
racter of lepra, or psoria- Mercury. 
sis, and unattended with 
any obvious degree of fever. 

2. Excavated ulcers of the ' The same local remedies as 
tonsils. prescribed for the several 

3. Pains in the joints, tibiae, symptoms in No. II. 
cranium, &c. 

4. Nodes. 



EXPLANATION OF THE PLATES. 



PLATE L 

Fig. 1. — The venereal lichen, or papular eruption. The spots 
are either mere pimples, or papulse, with acuminat- 
ed tops, containing matter situated on deep-red or 
violet-coloured bases. See Cases 1 and 6, 

Fig. 2. — An eruption of the same character as the preceding, 
but the spots considerably smaller and more numer- 
ous. See Case 3. 

Fig. 3. — The venereal lichen exhibited of a paler colour, and 
the spots more distinct than in figures 1 and 2. The 
spots exhibited in these three figures cannot possibly 
be mistaken for the syphilitic lepra, and can only be 
confounded with psoriasis syphilitica, when they 
have terminated in exfoliation of the cuticle, which 
gives them a scaly appearance. See Case 8. 

Fig. 4, 5, and 6. — Exhibit venereal tubercula. 

Figure 4. exhibits a tubercle previous to ulcera- 
tion. Figures 5. and 6. tubercles at the commence- 
ment of that process. 

PLATE n. 

The figure in this Plate represents the form of 
eruption which attends the pustular venereal dis- 
ease. With the exception of a couple of spots all 
the others had arrived at the scabbing stage. This 
eruption is in general of that form of pustule term- 
ed by Willan and Bateman phlyzacium ; less fre- 
quently it exhibits the appearance of the pustule 
termed favus. They do not, however, continue 
longer than one or two days in the pustular state 
before they begin to scab; and when the crusts fall 



348 EXPLANATION OF THE PLATES. 

off, either small superficial sores are exposed, 
which quickly heal, or the parts are found cica- 
trized. 

The phagedenic eruption delineated in Plate III. 
%. 1. is also pustular; but the ulcers which suc- 
ceeded the pustules are deep and spread with a 
phagedenic margin] and this circumstance, together 
with the phagedenic character of the primary ul- 
cers, induced me to name the latter form of dis- 
ease, the phagedenic venereal disease, 

PLATE III. 

Fic. 1. — An eruption of large and well-defined pustules, and 
the appearances of the ulcers which they formed. In 
the patient there was no opportunity of witnessing 
the primary ulcer, but as the eruption agreed in 
character with that of the phagedenic ulcer, it may 
be considered as appertaining to that species. See 
Case 23. 

Fig. 2. — A large conical crust of its natural size, which was 
formed by one of the pustules in figure 1. 

Fig. 3. — An eruption on the face of a male patient, in whom 
there was not an opportunity of seeing the primary 
ulcer, but as it agreed in general character with 
that traced to the phagedenic ulcer, it probably had 
the same origin. See Case 24. 

PLATE IV. 

The figure in this Plate exhibits an excellent re- 
presentation of the conical or limpet-shell-formed 
crusts (resembling the rupia prominens of Bateman,) 
which the eruption of the phagedenic disease fre- 
quently displays. See Case 26. 

PLATE V. 

Fig. 1. — Exhibits the syphilitic lepra; the spots form a firm 
elevation above the surrounding surface, and the 
circumference of each spot is still more elevated 
than its centre. On the shoulder is delineated a 



EXPLANATION OP THE PLATES. 349 

spot covered by a thick crust, which had proceed- 
ed to ulceration. 

Fig. 21. — The groin and upper part of the thigh of the same 
patient; an e:xtensive copper-coloured blotch is seen 
to engage the groin, which had partly degenerated 
into an ulcer, covered by a crust, with which the 
hair of the pubes was matted. 

Fig. 3.— a single syphilitic blotch, of a medium size, on the 
same patient. 

Fig. 4. — The syphilUic psoriasis. The spots, though possess- 
ing scaliness from the commencement, which is the 
•peculiar character of the syphilitic eruption, are 
much smaller and less elevated than the lepra sy- 
philitica. 



INDEX. 



Adams and Abernethy confirm 
Mr. Hunter's conclusions, 34. 
Ascertain that healthy animal 
secretions may occasion local, 
followed by constitutional dis- 
eases, ibid, Abernethy's cases 
elucidating this subject, 35. 
His opinions relative to dis- 
eases resembling Syphilis, 
134. 

Acetic Acid, a cure for Venereal 
Warts, ,100. 

Air, change of, recommended in 
the treatment of the slough- 
ing ulcer, 179. 

Anomalous symptoms of the 
Phagedenic form, 173. 

Antimonial Solution, 119. 

Anthrax of the Penis, 325. 

Astruc, his opinions relative to 
the ancient existence of geni- 
tal ulcerations, and the origin 
of Syphilis, 19. 

Bateman's Synopsis, referred to, 
relative to Venereal erup- 
tions, 138. 

Bark, injurious to the Sloughing 
Ulcer, 179. 

Balsam Copaivee, directions for 
its administration, 104, 105. 

Becket contends for the antiqui- 
ty of Syphilis, 53. Endeavours 
to prove that it was confound- 
ed with Leprosj^, 27. 

Bell, Benjamin, experiments by 
inoculating with the matter of 
Gonorrhcsa and Chancre, the 
results of which are opposed 
to those of Mr. Hunter, 80. 

Bladder, irritable state of, 144. 



Bleeding from the Urethra, how 
to arrest, 103. 

Bones, seldom or never affected, 
except where Mercury has 
been employed, 176. Of the 
Nose, affections of, in^ the 
Phagedenic form, 200. How 
to be treated, ib. Affections of, 
in the Scaly form, 299. 

Bougies, what sort best, 141. 

Button Scurvy, an affection pe- 
culiar to the Irish peasantry, 
14. Description of, ib. Its 
cure, 15. Might be mistaken 
for the eruption of the Pha- 
gedenic Venereal Disease, 
ib. Causes of, ib. 

Buboes, of the Papular Vene- 
real Disease, 82. Not ex- 
cited as some suppose by the 
application of caustic, 95. 
Treatment, 108, 109. Mer- 
curial frictions promote their 
tendency to suppurate, ib. 
Of the pustular form, 149. 
Their tendency to burrow 
under full courses of mercu- 
ry, 150. Diagnostics of the 
true syphilitic, 290. Never 
to be treated with mercury 
whee not preceded by chan- 
cre, 291. Character of those 
produced by the pustular 
form, 149. Their tendenc}^ 
to burrow, 150. Treatment, 
ib. Comparatively infi'equent 
in the phagedenic form, 167. 
Characters, ib. 



Canatlian Disease, 



Its pri- 



mary and secondary symp- 



35: 



INDEX. 



toms, £. Contagious and in- 
fectious, ib. Treatment. 9. 
■Only cured radically by mer- 
cury, 1^. Nature ot' the dis- 
ease, 10. I 

Caustic, when to be applied to I 
ulcers on the penis. 95. ; 

Celsus, and other ancient wri- j 
ters describe nlcers of the 
genitals, 19. 

Catarrh, its frequency accoant- ■ 
€d for, 74. 

Cervical glands, inflammation 
and ulceration of, during the 
papular eruption. 86. 

Chevallier. trite remark ot\ re- 
lative to the treatment of gon- ! 
shot wounds, 40. ! 

Chancres, see Ocers. i 

Chancre, characteristics of the • 
Hnnterian or true Syphilitic j 
variet}', 49. Testimonies, 
proving that it will heal with- 
out mercury. 53, 65. How 
to be disiiDguished from the 
sloughing ulcer. 2S9. Lately 
of rare occurrence. 316. 

Chancrous or patchy excoria- 
tion, its description and treat- ; 
ment. 100. : 

Chronic complaints improperly ' 
attributed to Venereal origin. 

Chordee. 101, 102. 

Cicuta. useful in the phagedenic 
term, 177. 

Cicatrix of the primaiy ulcer, ' 
will assist the diagnosis in the 
phagedenic lorm. 260. 

Cinnabar, factitious, fumigations . 
with, useful in ulceration of j 
the nares, &:c. of the phage- : 
denic form, 201. 

Ciassidcation of Venereal Dis- 
eases, upon what founded. 
58. Objections to, 64. Re- 
plies, ib. 

Coniinement, its importance do- 



ring the treatment of Syphi- 
lis. 116. 

Constitutional powers, when to 
be strengthened in the treat- 
ment of the papular disease, 
137. 

Constitutional symptoms of the 
difierent ulcere, 49. Best 
means of preventinsr. 58. 

Cutaneous diseases arisuag from 
defective digestion. 

Cubebs, 105. How to be ad- 
ministered for the core of go- 
norrhoea, 106. 

Diseases most likely to be con- 
founded with those of syphi- 
litic origin, 324. Cases of. 
331. Those produced by 
defective digestion, 329. 

Elephantiasis, not contao:ions, 
28. 

Epididynjis. indurations oJ^, when 
attended with danger to pro- 
creation. 142. 

Epiglottis, ulceration of, in the 
phagedenic form, 171. 

Eruptions, afford the true basis 
for the classiiication of vene- 
real diseases, 58, 62. Their 
variety, 5S. Vague descrip- 
tions of, 53, The Papular^ 
83. Liability' to recur, 86. 
Rendered more ot)stinate and 
complicated by the early use 
of mercury-, ib. Proper treat- 
ment. 87,'ilO. Should not 
be repelled, 113. Pustular 
described, 159. Its criterions 
and treatment, ib. The Pha- 
gedenic^ 168. The Scaly va- 
riety, 292. Dr. Willan"s de^ 
scription of, 294. Its usual 
seats, appearances and pro- 
gress, 296. All kinds of erup- 
tions show a tendency to glide 
into those of the nearest cha- 
racter, 158. Best way of as- 



INDEX. 



353 



certainin^ their true charac- 
ter, ib. Practical rule rela- 
tive to, 159. Case of, 160. 
The mercurial^ 3G6. 

Er3'sipelatous intiammalion of 
the penis, 325. 

Evans, Mr. his cases of inocula- 
tion with venereal matter, 
results, &c. 75, 76, 77. 

Excoriation of the glans and 
prepuce, 100, 101. 

Eyes, disease of, 88. 

Farre, Dr., his reason why mer- 
cury arrests inflammation of 
the iris, 129. 

Fauces, ulceration of, in the 
phag-edenic form, 197. 

Females, most easily affected 
by mercury, 307. 

Ferguson's observations on the 
venereal disease in Portugal, 
264. 

Fistula in perineo, 107. Its na- 
ture and treatment, 142. 

Fowler's solution used success- 
fully in tbe treatment ofsome 
obstinate ulcers, 328. 

Fumigations with sulphur*, use- 
ful in the pustular eruption, 
159. Of the sulphuret of 
mercury, 197, 198. 

Genital organs, peculiarity of 
their structure, and suscepti- 
bility to disease, 17, 18. 

General principles, should regu- 
late the treatment of syphi- 
lis, 41. 

Gleet, 105. Cure of, 106, 145. 

Gonorrhoea, when first describ- 
ed as a symptom of syphilis, 
81. Its nature 80, 81, 82. 
Mercury, by some, thought 
necessary for its radical cure, 
43. May produce the papu- 
lar eruption, 7 1 ; and primary 
venereal ulcers, 76. Opin- 
ion§ of Whately and Munro 

2 



relative to its nature, kc. 70.. 
Occasioned by the same poi- 
son, which gives rise to the 
simple primary ulcer and ex- 
coriation of the glans, 71, 
Rarely occasions constitution- 
al symptoms, 72. The cause 
of their infrequency explain- 
ed, ib. When most virulent, 
102. Treatment, 101. The 
proper diluent drinks, 102. 
How to allay the painful erec- 
tions and chordee, 102, 103. 
To stop hsemorrhage from 
the urethra, ib. Watery ef- 
fusions into the prepuce often 
produced by a stoppage of 
the discharge, ib. Warm fo- 
mentations useful in the in- 
flammatory stage, 104. Cir- 
cumstances regulating the 
exhibition of the balsam co- 
paivse, ib. Formula and di- 
rections for its proper ad- 
ministration, 105. Cubebs, 
when and how to be used 
with advantage, 106. The 
use of strong injections of the 
nitrate of silver deprecated, 
104. The most proper in- 
jections, 106, 107. Suppu- 
ration of the lacunae of the 
urethra, 145. Peculiarities 
of the disease in women, 146. 

Guaiacum, or lignum sanctum, 
192. Wonderful eflicacy 
once ascribed to it, 193. 

Guthrie, his remarks on the 
non-mercurial treatment, 115. 
Reply to his objections tMhe 
author's opinions, 269. 

Harris^.Dr., his testimony in fa- 
vour or the non-mercurial 
practice, 55. 

Haemorrhage, from the urethra, 
means of arresting, 103. 
From the phagedenic ulcer. 



354 



INDEX. 



163. Often salutary, 162, 
179. Sometimes should be 
encouraged, 178. 

Herpes pnEputialis, 326. Treat- 
ment, 327. 

History of cases, if too much at- 
tended to leads to ambiguous 
practice, 65. Not to be ne- 
glected, where the circum- 
stances are doubtful, 136. 

Hospital patients recover most 
rapidly from venereal com- 
plaints, 116. 

Hospitals, afford the best op- 
portunities of acquiring a 
knowledge of venereal com- 
plaints, 361. 

Hunter, the first to discriminate 
between syphilis and those 
affections which resemble it, 
30. Cases elucidating his 
opinions, 31. Cases arising 
from the transplantation of 
teeth, 33. His criterion of 
true chancre no longer ad- 
missible, 63. Opinions rela- 
tive to diseases resembling 
syphilis, 132, 133. Descrip- 
tion of the primarj^ venereal 
ulcer, 286. 

Jenner, his axiom, relative to 
cutaneous diseases, 113. 

Inflammation, curious patholo- 
gical law of, 169. 

Inoculation with venereal mat- 
ter, by Evans, 75. By Hun- 
ter and Benj. Bell, 80. 

Injections, strong ones of the ni- 
trate of silver condemned, 
104. 

Joints, affections of, attending 
the phagedenic form, 172. 

Ipecacuanha, compound powder 
of, successful in allaying pains 
of the joints, &c. 194. 

Iritis, or inflammation of the 
iris, 88. 127. Attends the 



papularform,90, 127. Yields 
to mercury, 128. Although 
this medicine is not absolutely 
necessary, 129. Treatment, 
ib. Conclusions drawn from 
numerous cases, 131. 

Irritable state of the bladder, 
nature and treatment of. 144. 

Itch, the three orders of its 
eruptions, 158. 

Knee joints, inflammation and 
swelling of, occurring in the 
phagedenic form, 172, 173. 
Tre^atment, 206. 

Larynx, ulceration of, in the 
Phagedenic form, fatal, 171, 
199. Indications of, 202, 
Treatment of, 203. Fatal 
case of. 255. 

Lacunae of the urethra, inflam- 
mation, suppuration and fistu- 
la of, 145. 

Lepra Septentrionalis or North- 
ern Leprosy, 10, Causes of, 
12. Mode of averting and 
treatment, 13. Should be 
placed among the exanthe- 
meta, 14. Supposed to be 
the same disease as Sivens, 26. 

Lepros}'^ not a contagious dis- 
ease, 28. Willan's descrip- 
tion of the Venereal variety, 
294. 

Lead-water, its use as an injec- 
tion condemned, 106. 

Linn^us classes syphilis with 
the exanthemata, 112. 

Lungs, effusions into, from the 
incautious use of mercur}', 
313. 

Matter of constitutional ulcers 
incapable of communicating 
the original disease, 300. 

Mercury, its exhibition for the 
cure of syphilis, should be 
regulated by the general 
principles of medical science. 



INDEX. 



355 



41. Its abuse, ib. Horrid 
effects, 56. Not to be re- 
garded as a specific, 42. Its 
nse in gonorrhoea condemned, 
ib. Affections improperly as- 
cribed to it, 42. Extent of 
its deteriorating influence, ib. 
Its exhibition unnecessary for 
the cure of primary ulcers, 
53. Its power of protecting 
the constitution from second- 
ary symptoms doubted, 54. 
Not employed with such 
views in the south of Europe, 
ib. Entirely dispensed with 
by some practitioners in the 
treatment of ail the varieties 
of syphilis, 54, 55. Should 
never be administered for the 
cure of the primary phage- 
denic and sloughing ulcers, 
56. When to be given in other 
primary ulcers, ib. A full 
course to protect the consti- 
tution from secondary symp- 
toms disapproved, 57. Used 
too early in the papular form, 
renders the eruption and 
other attendants more obsti- 
nate and complicated, 86. 
The best time to administer it, 
87. When to desist from its 
use, 88. Rules for its proper 
exhibition, 93, 94, 118. Pre- 
maturely used in the phage- 
denic form, occasions its ob- 
stinacy, 175. Transfers the 
disease to the deep seated 
parts, ib. May retard or sus- 
pend the constitutional symp- 
toms of the phagedenic form, 
but will not make a radical 
cure, 209. Its use in altera- 
tive doses condemned, 194. 
When to be resorted to, 195. 
When the proper stage for 
its exhibition may be infer- 



red, 236. Preparations of, 
adapted to particular cases 
and circumstances, 196. Ra- 
pidly cures the constitutional 
affections of the soft parts in 
thescaly variety, 300. Nodes 
yield less rapidly to it, ib. 
Less of it necessary in Hos- 
pital than in private practice, 
303. Affects women most 
easily, 307. Produces its ef- 
fects most readily and in very 
small quantities in persons ha- 
bituated to its use, 308. Its 
modus operandi in the cure 
of syphilis, 302. Proper 
length of a course, 301. To 
be used with great circum- 
spection when there exists 
any affection of the chest, 
311. Its fatal consequences 
in such cases, 312. Its cha- 
racteristic operations upon 
the system, 313, 314. How 
to obviate its bad effects, 314, 
315. Bad consequences at- 
tending its early exhibition in 
the phagedenic form, exem- 
plified by cases, 211. Non- 
mercurial treatment, cases 
of, 317. 

Mercurial disease, arguments 
opposed to its existence, 42. 
Fumigations, 201. Frictions 
instead of discussing buboes 
increase their tendency to 
suppurate, 108, 109. Phage- 
dena, 303. Pains, 306. Erup- 
tion, 306. Debility, 309. 
Nodes, their existence doubt- 
ful, 305. 

Morbid poisons which excite 
fever and syphihs, curious 
facts relative to, 1, 73. In- 
creased action of the system 
removes the former but not 
the latter, 2. Inflammation 



356 



INDEX. 



and suppuration oppose their 
introduction into the system, 
73. 

Mucous surfaces, effects of con- 
tagious matter upon, 73. 

Nares, ulceration of, in the 
phagedenic form, 170, 171. 
Treatment of, 200. When 
the exhibition of mercury is 
proper, and the best prepa- 
rations, 201. Country air and 
milk diet recommended in 
these aifections, 202. 

Nose, affections of its bones, a 
characteristic of the phage- 
denic species, 264. Cases ex- 
emplifying the proper modes 
of treatment, 259. Frequent 
affection and loss of in Portu- 
gal, accounted for, 172. 

Nitric acid, in what cases use- 
ful, 309, 265, 274. Modes 
of administering, 122, 230. 
Useful in the tubercular erup- 
tion of the phagedenic form, 
193, 194. 

Nodes, afford uncertain diag- 
noses for discriminating the 
forms of syphilis, 60. What 
forms produce them, ib. 
Their absence, one of the 
characteristics of the papu- 
lar form, 91, 115. Diftereat 
from those swellings which 
sometimes occur over the ti- 
bi33, 92. Those of the pha- 
gedenic form attributed to 
the use of mercury, 173. 
Their treatment, 205, 207. 
Characters of the true syphi- 
litic, 299. Such yield slowly 
to mercury, 300. The ex- 
istence of mercurial nodes 
dou'oted, 305. 
Nomenclature of venereal dis- 
eases, a new one proposed, 62. 

Nostrums, their celebrity ac- 
counted for, 91. 



Opium, and other narcotics re- 
commended in the treatment 
of the phagedenic form, 177, 
179. 

Pains, not to be reckoned among 
the diagnostic symptoms in 
the classification of syphilitic 
complaints, 60. Seats of them 
in the different forms, ib. 
In the papular form, 135. In 
the syphilis, 299. Of the 
joints, 205. Of the bones and 
joints proceeding from defec- 
tive digestion. 

Papular venereal disease, 67. 
The most simple and easily 
cured of all other forms, 
ib. Primary symptoms, ib. 
Secondary or constitutional 
symptoms, 83. Absence of 
nodss one of its characteris- 
tics, 91. Treatment, 92. 
Eruption described, 83. Lia- 
ble to return, 86. Rendered 
worse by the improper use 
of mercury, ib. Will yield 
to the unassisted powers of 
the system, 1 10. Cases of, 
119, 127. Eruptive fever 
more violent than that of 
the scaly variety, 135, 137. 
When it may be considered 
as radically cured, 114. Its 
general treatment like that 
of yaws, 117, 118. 

Pustular form, defined, 62. 
Characters of its primary ul- 
cers, 147, and of its buboes, 
149. Obstinacy of the pri- 
mary ulcers under the use of 
of mercury, 150. Treatment, 
151. Casesof the, 151,160. 
Constitutes the connecting 
link between the papular and 
phagedenic forms, 161. 

Pathology, general principles 
of, to be followed in the treat- 
ment of syphilis, 112, 208. 



INDEX. 



357 ^ 



This doctrine inculcated by 
Dr. Rush, 41. 

Poison of Gonorrhoe?., its identi- 
ty with that producing- the 
simple primary ulcer, 80, 81. 

Patchy excoriation of the glans 
and prepuce, 100, 101. 

Panaceas and antisyphihtic nos- 
trums generally contain some 
preparation of mercury, 233. 

Perplexity occasioned in the 
treatment of syphilitic affec- 
tions by ignorance of the true 
characters of the symptoms, 
65. 

Penis, inflammation of, and its 
attendants, 97, 324. Erysi- 
pelatous inflammation of, 325. 

Phymosis, most commonly an 
attendant of the papular form, 
68. Nature and source of 
the discharge which accom- 
panies it, 69. Treatment, 93, 
96. Does not often attend 
the scaly form,- 290. 

Phagedenic form, 50, 62, 162. 
Its predisposing causes, 65. 
Characters of its primary ul- 
cer, ib. Probably originates 
from the same kind of virus 
as the other forms, 164. 
Treatment of its primary af- 
fections, 168. Its constitu- 
tional symptoms, 50, 168. 
Characteristic signs of the 
disease, 169. Ulceration of 
the throat, 170. Treatment, 
177, 178. Nodes of this va- 
riety, 173. Premature use 
of mercury thought to occa- 
sion their obstinacy, 175. 
Compared to the yaws, 176. 
Treatment of the secondary 
symptoms to be conducted 
upon general principles, 191 , 
192. Mercury in alterative 
doses protracts the disease, 



194. Its use not to be alto- 
gether dispensed with, 195. 
Treatment of its ulcers, 178, 
179. The cicatrix of the 
primary ulcer will assist our 
diagnosis, 260. Cases of, ex- 
emplifying the effects of mer- 
cury, 211. Others exempli- 
fying the non-mercurial plan, 
238. Treatment of the se- 
condary symptoms, 191. Por- 
tuguese practice, 265, 266. 
Case showing its malignancy 
in Portugal, ib. 

Plummer's powder and pills, 
useful alteratives. 111. 

Portuguese physicians abstain 
from the use of mercury in 
the phagedenic form, 266. 

Ptyalism, occurring without the 
use of mercury, 298. 

Prepuce, inflammation and 
sloughing of, 97. Watery ef- 
fusion of the, 103. Vesicu- 
lar eruption of, 324. Phleg- 
mon of, ib. Treatment, 325. 

Pulmonary affections aggravat- 
ed and sometimes rendered 
fatal by the use of mercury, 
311. 

Radesyge, a disease common to 
the north of Europe, 10, 113. 

Relapses, most frequent after 
the mercurial treatment, 340. 

Rose, Mr., his remarks relative 
to the non-mercurial treat- 
ment of syphilis, 115, 315. 

Rush, professor, predicted that 
the venereal disease would 
be treated upon general prin- 
ciples, 41. 

Salivation ought always to be 
avoided, 315. 

Sarsaparilla, how prepared and 
exhibited, 118. 

Scaly form of syphilis, its pri- 
mary ulcer, 286. Constitu- 



358 



INDEX. 



tional symptoms, 291. Cha- 
racteristic eruption, 292. Ef- 
fects upon the bones and other 
deep-seated parts, 299. Its 
multiform appearances ac- 
counted for, 301 . Scaly erup- 
tions of all kinds benefitted 
by mercury administered in 
their declining stages, 196. 
Cases treated without mercu- 
ry, 317. The cure in all its 
symptoms and stages expedit- 
ed by mercury, 321. 

Scrofula, supposed to be caused 
by a disordered condition of 
the chylopoetic viscera, 329. 

Scropbulous children, cause of 
their amendment when sent 
to the sea-shore, 116. 

Secretions of the genital or- 
gans capable, when altered 
or vitiated, of occasioning ve- 
nereal affections although no 
disease be apparent, 78, 79. 
Even when healthy, may give 
rise to troublesome ulcers 
when applied to abraded sur- 
faces, 81. 

Sivens, an endemic of Scotland, 
supposed to be a modification 
of syphiHs, 5. Characteris- 
tics and seat, 6. Occasional- 
ly met with in Ireland, 7. 
Suspended, but not radicallj"^ 
cured by mercury, ib. 

Sinuses ensuing to buboes, &:c. 
145. 

Sloughing ulcer, its characteris- 
tics, &c. 163. Most prevalent 
in the south of Europe and 
southern latitudes, 1 64. De- 
scribed by Celsus, 165. In 
what respects it differs from 
sloughing from other causes, 
1 67. Local and general treat- 
ment, 168, 178, 179. Con- 
stitutional symptoms, 179. 



Prognosis in, 180. Cases of, 
185, 190. Destructive ten- 
dency, 191. Greater preva- 
lence of a few years back, 
321. 

Sraall-pox, its particular law and 
character, 17. DiflEiculty of 
ascertaining its character, 
158. 

Strictures in the urethra, 107, 
140. Treatment, 141. 

Strangury, 148. 

Surgeons attached to the army 
have the best opportunities of 
investigating the nature of 
venereal complaints, 74. 

Sulphurous fumigations, useful 
in the declining stage of the 
pustular eruption, 159. 

Swellings of the legs from mer- 
curial debility, 309. 

Synopsis of venereal diseases, 
341. 

Syphilis supposed to have been 
introduced into Europe by 
Columbus, 30. This opinion 
questioned, 37. 

Syphilitic, syphiloidal and pseu- 
do-syphihtic terms objected 
to, 43, 61. 

Swelled testicle, 107. 

Testicles, inflammation and 
swelling of, 107. Prevention 
and treatment of, 142. En- 
largement of in the phage- 
denic form, 173, 208. 

Terms, substitution of, propos- 
ed by the author, 64. Reasons 
in favour of the substitution, 
64,65. 

Throat, affections of not to be 
considered as diagnostics in 
the arrangement of the forms 
of syphilis, 59. Soreness of, 
a characteristic of all febrile 
cutaneous diseases, 85. Very 
common to the papular form. 



INDEX. 



359 



ib. Character of the ulcera- 
tion attending" the papular 
form, 1 35. Ulceration of, at- 
tending the phagedenic form 
of the worst character, 170. 
Its treatment, 197, 198. Ul- 
ceration of, in the scaly form, 
297. Ulcers in, produced by 
defective digestion, 329. 

Thompson, Dr., has long treat- 
ed all venereal complaints 
without mercury, 54. His 
treatment of iritis, 129. 

Tracheotomy, a dernier resort 
in ulceration of the larynx, 
204. 

Travers's remarks relative to 
the treatment of iritis, 127. 

Tubercular cutaneous eruption 
in the phagedenic form treat- 
ed with nitric acid, 193. 

Ulcers not syphilitic, to which 
the organs of generation are 
liable, 15. Described by 
ancient writers, 19. Quota- 
tions relative to, made by As- 
true, ib. Becket's investiga- 
tions upon the same subject, 
23. Those of the phagedenic 
and scaly forms contrasted, 46. 
The most common venereal 
primary ulcers, 47. Charac- 
ters of their constitutional 
eruptions, 48. General treat- 
ment of ulcers, 50. Attend- 
ants of the various kinds de- 
scribed 49, 50. Difficulty of 
deciding upon the character 
of those arising from morbid 
poisons, 51, 52. The true 
• syphilitic curable without 
mercury, 53, 54, 55. Treat- 
ment of the primary simple 
ulcer, 55, 58. To be consi- 
dered as the second symp- 
tom in forming a classifica- 
tion of venereal complaints, 



59. May be modified in their 
appearance by the influence 
of mercury, 50, 167- Exca- 
vation of the tonsils and throat, 
improperly regarded as the 
characteristic of genuine sy- 
philis, 60. Simple primary 
defined^ 67, 68 ; most common 
of all others, 67. Usual situ- 
ation, appearance, &.c. 68, 
69. Occasioned by altered 
secretions where no appear- 
ance of disease exists, 78, 79. 
Treatment, 93, 96. Indolent 
ulcers of the legs cured with 
alterative doses of corrosive 
sublimate, 93. Primary of 
the pustular form ^ 141. Ob- 
stinacy under the use of mer- 
cury, 150. Treatment, 151. 
Phagedenic and sloughing ul- 
cers, 50, 162. Primary of 
the scaly variety, 286. Ef- 
fects of mercury upon it, 288. 

Ulceration, the organs of gene- 
ration, peculiarly liable to, 
17. Such as are produced 
by animal secretions, may be 
followed by secondary symp- 
toms, 18, 34. Cases of, 35. 
Of the throat in the phage- 
denic form, 170. Of the la- 
rynx, 202. Treatment, 203. 
Of the nares, 199. Difficul- 
ty of their treatment, 200. 
Author's plan, 201. Of the 
throat and tonsils attending 
the scaly form, 297. 

Vaccine and variolous poisons, 
interesting facts relating to, 
73. 

Valenciennes, public women of 
examined, 78. 

Velno's vegetable balsam, 233. 

Venereal disease, severe laws 
formerly existing against per- 
sons aflfected with it, 24. Cu- 



360 



INDEX. 



rioos instance of its originat- 
ing" among some relis^ious 
nuns, 24. Its antiquityr 37. 
Spontaneous production from 
promiscuous intercourse, ib. 
Identity of the poison, ib. 
General observations relating 
to, 38. Curable in every 
form and stage without mer- 
cury, ib. Xodes, ic. seldom 
occur when mercury has not 
been employed, ib. Treat- 
ment upon general princi- 
ples, ib. Xon-mercurial treat- 
ment thought tobe more slow. 
39. Its advantages, ib. Ar- 
guments in favour of a plu- 
rality of venereal poisons, 44. 
45. Plan proposed for the 
investigation of these sub- 
jects, 46. The most proper 
basis for the arrangement of 
venereal diseases, 58. Au- 
thor's plan, 62. Venereal 
complaints communicated by 
those who exhibit no signs of 
disease, 78. Poison, when 
most virulent, 75. The dis- 
ease classed by Linnseus 
among the exanthemata, 112. 
The papular form, 67. P-mtu- 
lar form, 147. Phagedenic 
form, 162. Scaly form, 286. 
The forms influenced by epi- 
demic causes, 322. 
Vis medicatrix naturae, remarks 
upon its nature, 233. 



Warts, Teuereal, 6^. Their 
cure, 99, 100. 

Whately's observations relative 
to the nature of gonorrhoea, 
kc. 70. 

Willan, valuable effects of his 
labours, 52. The first to 
classify cutaneous diseases 
according to their external 
characters, 294. His descrip- 
tion of the venereal erup- 
tion, ib. 

Women may communicate ve- 
nereal complaints without 
having any apparent disease, 
79. Their different confor- 
mation modifies their com- 
plaints, 146. Remarks rela- 
tive to their treatment, ib. 
More susceptible of the ef- 
fects of mercury than men, 
307. 

Yaws, 2, Considered the con- 
necting link between syphi- 
lis and small-pox, 3. Cha- 
racteristics, ib. After reco- 
very the susceptibility to the 
disease lost, 2. Active medi- 
cines retard its cure, 3. Ill 
effects of mercury, 3, 113, 
176. Treatment,"' 3. 117. 
Compared with the phage- 
denic form, 176. Wears it- 
self out, ib. 



THE END. 



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